Stages of Engagement Framework

Productive engagement can be complex with three phases (Pre-Engagement, Engagement and Contracting). The chart below presents these phases with corresponding, appropriate interventions to help foster effective communication.

Phase	Intervention
Pre-Engagement Trust vs. Mistrust Safety Issues	Observe Identify potential patient Respect personal space Assess safety Attempt verbal and non-verbal communication Offer essential need item(s) Listen for client language Establish initial communication, etc.
Engagement Trust vs. Mistrust Dependency Issues Boundary Issues	Communicate with empathy and authenticity Learn patient’s language Actively listen by reflecting person’s words, ideas, values Identify and reinforce person’s strengths Provide unconditional regard Avoid power struggles Emphasize joining the resistance Introduce roles, begin and continue healthy boundaries Establish on-going communication Identify current life stressors, etc.
Contracting Autonomy vs. Shame Issues of Control Initiative vs. Guilt	Further define roles and boundaries Address shame by universalizing human frailty Review patient’s strengths Negotiate reachable goals to alleviate life stressors Explore person’s history around goal setting and achievement Determine eligibility for resources and services Further define shared objectives Review and reinforce current coping strategies, Seek permission to register/enroll patient for treatment

Figure 26. Stages of Engagement Framework. Adapted from Levy JS.³⁶