By: Dr. John S Lyons
Engagement is the second key decision point in the TCOM conceptual framework. Historically in most helping professions we have thought of engagement as primarily personal and often between two people. A therapist engages a client in mental health treatment. A substance treatment provider engages a person in their recovery process. A case worker engages a child in child welfare. While these personal relationships are clearly powerful and important in creating transformational experiences, we also work in environments in which the professionals change frequently. It is not uncommon for therapists in public clinics to work one year until they get licensed and then move to more lucrative employment elsewhere. Turnover rates in child welfare case worker positions have been reported between 20% and 40% annually. The duration of a person’s experience in the helping system is often far longer than the duration of employment of any of the people who are charged with ‘engaging’ that person. Our business model of trying to pay direct care staff as little as possible so that more people can be served works at cross purposes with our conceptualization of engagement.
Absent a major new investment in workforce salaries, this problem is likely to be with us for the foreseeable future. So what can we do to facilitate engagement, recognizing that personal relationships with professionals are often transient in the public system? One strategy is to broaden our concept of engagement to include institutional engagement. In other words, we consider the “relationship” of people to be helped to be between those people and the programs and agencies they are involved in rather than simply between the person and the professionals who work in those agencies. Forming a bond between a person and the program and/or agency that is attempting to help offers an additional route to effective engagement that may be less affected by high turnover. If a person feels a meaningful connection to a program or to an agency then maybe they will keep working with different people in that program or agency.
Of all the agencies I have visited, perhaps the one that does this type of engagement the best is Boystown. Given its well-known history, Boystown, as an institution, has a meaning that transcends the current staff. In talking with youth served in various programs there, it is clear that while they talk about relationships with key staff, they also have a bond with the agency that goes beyond any personal relationships with individual professionals. There are numerous agencies that have similar historical footprints that allow this form of engagement both in the U.S. and around the world. I was affiliated with the Children’s Hospital of Eastern Ontario (CHEO) for six years. CHEO has a long history in the community in the Ottawa region of Ontario which has resulted in a stellar reputation as a caring institution. This reputation provides a buffer during times when individual relationships between professionals and patients and their families are problematic.
Of course, one way to help build ‘brand loyalty’ to a program or agency is through staff who are already committed to that program or agency. Staff who are engaged in their work and share the values and mission of their employer are much more likely to be successful engaging the client/ customer/patient in the process of personal change. Happy employees are obviously better at ‘branding’ a program and agency than bitter or disgruntled employees.
Another strategy for establishing institutional engagement is a history of effective service to others. However, not all agencies have the advantage of long and distinguished histories of caring. So what strategies can agency and program leadership use to increase engagement beyond ensuring engaged employees? It is useful to look at the research on establishing brand loyalty as a framework for thinking through this type of engagement. Ryan Westwood writing in Forbes magazine provides the following three keys:
- Your brand should inspire
- Your brand should be consistent
- Your brand should support your company’s core values
Making it clear that the agency or program is designed for the success of those who seek help and telling the story of that success is important. It is inspirational. Ensuring that every professional in the program or agency approaches the work in a similar fashion that is consistent with the values of the program or agency is also important. These three recommendations describe the Boystown approach quite well.
Also in Forbes, YEC Women recommends the following seven tips (from “7 Tips for Building Brand Loyalty in a Discount Obsessed Market,” October 25, 2011):
- Keep quality high.
- Engage your customers.
- Solicit feedback from consumers.
- Give them a reason to come back.
- Stay relevant.
- Provide Value.
- Show your appreciation.
You can see how the strategies in TCOM are designed in a fashion that allows a program or agency to incorporate all seven of these recommendations into an essential structure of the core approach to its work. Consensus-based assessment processes to engage immediately and stay relevant, followed by the use of personal status information to monitor and celebrate success and to demonstrate value and show appreciation for personal progress, are core processes of TCOM.
Even state agencies would benefit from this form of institutional engagement. For example, when a state employee decides that the state will make a better parent than the current parents, even if temporarily, the state has the immediate responsibility of engaging that child as their own. That is not simply the child’s relationship with their caseworker and foster parent. It is also that child’s relationship with the child welfare agency. Regardless of whether the “parent” is a biological parent, foster parent, or the state, or whether there is a therapist, case worker or other helping professional involved, engaging the person is critical to the success of the work, and we may need to find creative ways to do this in an environment of staff-level instability.
I have had the experience of working in a child serving system that was accredited by the Sanctuary Institute. I would agree with the idea that quality in a high turnover industry is tied more to the culture than staff retention. There can be some corelation between culture and retention, but low salaries serve limit the potential influence of a strong culture of caring on retention rates.
The measurement of fidelity – how the culture is articulated by individual staff at the interface with individuals served by the system, across a variety of typical interactional contexts, is key.
Many branded quality platforms, either DIY or consultant led, rely of analysis of documentation and aggregate “customer” quality surveys to determine fidelity. If the aim is to actually know that the culture of caring is embedded, I think it is necessary to include direct observation of how staff interact with each other and with the people served by the system.
Hi John-Thank you very much for sharing your insights. Your point on how a culture of care relates to measurement of fidelity in the system is one that should be explored further. We’d love to craft this into a separate post if you are interested in writing!