Three phases to enhance completion of interventions

Completion rates for community based programmes for a range of issues are often low (between 30 – 35% for AoD and community based stopping violence programmes) while completion rates for prison based drug treatment programmes is higher at around 71%. One of the key challenges that exist for any correctional system is to ensure that the right person, has access the right interventions, at the right time. Embedded in this notion is the idea that these ‘right people’ also need to be intervention ready, to maximise the opportunity they are afforded through programme access.

We know that when people drop out of interventions, their behaviour becomes worse. This can be in terms of both severity and frequency of behaviour. This is probably not surprising as any failure experience has to be either internalised or externalised; in other words we have to act on it in some fashion. In the case of issues such as family violence, there is a tendency to externalise this failure experience which translates into others being more at risk of harm.

In my view, there are three distinct stages of work in getting someone from the start to finish of engagement with programme delivery. They are simply:

•             Pre-intervention motivation

•             Supporting the person while they are engaged with interventions

•             Supporting the maintenance period of change post programme.

Let’s open up each of these and see what tasks and behaviours relate to each.

Phase 1  Pre-intervention motivation

Unless the person is well engaged at the front-end of the intervention, it is unlikely they will survive the challenges that facing up to behaviour entails. The following ideas will be most helpful:

• Appropriate matching to the intervention – people will not be motivated if the intervention is not relevant or matched to their presenting issues.
• Building a vision of the future including the good life – having a vision of what might be possible is likely to generate energy for change and keep us on track. It provides a map of where to head.
• Identifying intrinsic motivation – if we don’t know how the intervention will enhance our lived reality and that there will be some payoff for the effort of exposing our vulnerabilities, then we are unlikely to persevere with change.
• Identifying an audience for change – change is always hard work. Without a support team around us who can share in the struggle and challenge of change, we can often feel isolated and give up.

Phase 2 Supporting the person while they are engaged with the intervention

• Maintaining engagement with the programme – keeping people engaged is really, really important. We often get people engaged then don’t inquire with them about how they are finding it, what is helpful, what isn’t. Then they miss a session. Once a person misses one session, it is easy to miss a second, and so forth. If someone doesn’t attend, what attempts do we make to re-engage?
• Being an audience for change – being able to reflect about what is different, how life is better (or worse) and helping to bridge the work carried out during the session into someone’s life away from the session helps to maintain engagement.
• Strengthening commitment to change – affirmation of every step towards change is useful. It is encumbent upon us to notice these steps and let the person know that we have noticed them.
• Conversations with others outside the group – keeping everyone on the same page and encouraging conversations of difference will help to create energy for change.

Phase 3 Supporting the maintenance period of change

• Conversations around how safety/relapse plans are working – hopefully by now there has been an audience for change that walks with the person into their future. Helping this audience to know what the signs of relapse are and how to have conversations if they appear is a great investment. Safety plans are only as good as how thought-out and transparent they are.
• Working with hot issues –managing the hot issues early is the only way to avoid relapse. Whoever is helping the person to manage their reintegration needs to be ready to respond promptly. Acute risk factors (alcohol and drug use, loss of employment, mood shifts, etc ) can change very quickly.
• Family involvement and widening audience for change – over time we would hope that the quality of the wider family support will grow.

I have continued to argue that programme attendance, by and of itself, is insufficient to consolidate change. We need to clearly identify strategies and ideas to reinforce and support change so that it becomes a permanent part of a persons everyday existence. These are my ideas. Love to hear yours.

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