3 Ways R1 Can Help Drive Engagement in Telehealth Programs

I remember a team building exercise I played once at a treatment center. I can’t recall the name, but the goal was for a ‘leader’ to verbally guide two blindfolded individuals from one side of the room to the other. The floor was strewn with ‘mines’; various objects around which the leader had to guide the others. The leader couldn’t use names and was limited to using a vocabulary of only a handful of words, none of which were the obvious directional terms one would instinctively reach for. It forced all of us to rethink how we communicate and how we lead. How do I guide individuals safely around barriers and obstacles without using the tools I have always used?

I was reminded of this game as I was reading more and more stories about treatment centers grappling with how to maintain effective programs in a period of social distancing, self-quarantines, and limited group sizes. The coronavirus pandemic has forced rapid and massive change on everyone. Social distancing and containment measures have been imposed in the U.S. and elsewhere. For substance use disorder programs, keeping clients engaged with their treatment is a challenge even in the best of times. It is becoming exponentially more difficult as outpatient programs are being suspended to forestall community spread and residential programs curtail outside events such as 12 Step meetings and limit group sizes. We have all been forced to rethink how we communicate with our clients, colleagues, and staff.

How does one guide clients through the minefield of early recovery when the customary tools and resources are unavailable? Likewise, How do we keep staff engaged in routine training and continuing education from a distance? How do we adhere to our standard policies and procedures in this climate?

Engagement - The Key to Effective Treatment

The term “engagement” is often interpreted to simply mean “attendance.” But “engagement” better refers to the degree of participation, attention, curiosity, interest, optimism, and passion that people show when they are being taught and are learning. Learning tends to suffer when learners are bored, dispassionate, disaffected, or otherwise “disengaged.”

We’ve been working closely with the Psychiatric Institute of Washington (PIW) to implement the R1 Learning System, Learning Labs, and Discovery Cards into parts of their programming. PIW has been placing decks of Discovery Card topics in common areas of their facility. We’ve heard, from multiple PIW staff, that they’ve found clients picking up the decks and holding their own informal sessions. That individuals are spontaneously forming their own small groups to use the Discovery Cards – on their own time – may be the most gratifying endorsement we’ve heard yet. To us, that epitomizes engagement.

Physical disengagement is a major obstacle to keeping clients involved and interested in their treatment. Moreover, growing uncertainty about one’s physical and financial health undoubtedly exacerbates anxieties and undermines the ability of programs to deliver the type of stable environment that nurture nascent recovery. This situation is not limited to clients. Workforce effectiveness can be hindered by these same factors. With these considerations in mind, we would like to illustrate a few ways that the R1 Learning System and Discovery Cards can help maintain a high level of engagement with discussion and activity-driven sessions on evidence-based topics during this challenging time.

Virtual Treatment Sessions: This may be the single largest challenge facing many treatment providers during the outbreak – How do we keep individuals and groups engaged when participants are now physically isolated. Virtual sessions are the obvious solution to this dilemma. The U.S. Department of Health and Human Services (HHS) granted a temporary waiver of certain HIPAA requirements as a way of facilitating fast implementation of telehealth treatment and many programs have been implementing these practices.R1’s Discovery Cards have been structured such that they can be implemented remotely while maintaining the features that make them engaging. Group Kits include everything needed to run effective groups, either in-person or virtually. With a card deck for each group member, sessions can be run via Skype/Zoom or other telehealth modes. Discovery Cards spur discussion and worksheets can be distributed, completed, and submitted electronically. This arrangement works equally well for both group and one-on-one sessions .

Virtual Practitioner Training: You can use this same approach for offering professional development opportunities to your clinicians, recovery and peer coaches, and broader workforce. Just because your team is not in the same room doesn’t mean you can’t engage them with continuing education opportunities. The R1 Learning System provides a comprehensive and modular approach for focusing on one topic at a time or several, through a series of 60-90 minute sessions over time. Focusing on one topic at a time helps maintain focus in virtual classrooms and allows individuals to walk away with new knowledge they can apply immediately. Activity-based learning with hands-on tools ensures that everyone is engaged. It also keeps everyone focused and participating in the discussions and not answering emails or doing other work on their second monitor.

Virtual Clinical Supervision: Now that your clinical team may be working remotely, how will you maximize your time for clinical supervision and document it for compliance purposes? One practical solution for reaching the most members of your team at one time, teach and coach on relevant topics, and document the learning, is with the Discovery Cards Group Kits. When focusing on a specific topic, distribute a deck to each team member and invite them to a virtual session. Here are a few ideas for using the R1 tools when hosting these sessions:

Motivational Interviewing: Use the Stages of Change Discovery Cards for targeted activities and group discussions. Test your team to put each behavior into its correct stage pile. Have each team member pick a card and have the group brainstorm motivational interviewing questions to ask. The opportunities for learning are endless. At the end of the session, each team member has a tool to use with clients in groups or one-on-one settings. Everyone benefits.

Emotional Regulation: Use the Emotions & Feelings Facilitator Guide and Discovery Cards to explore how each team member explains the emotions theory and process to clients. Use the 8 Core Emotions model and cards to explore ways to engage clients about what they are feeling given their own triggers and circumstancdes. Use the Emotional Regulation Practices as a way to share group members’ knowledge on best practice coping skills and actions for building resilience. These models provide a context for all to share their own knowledge and tools in an organized way.

Relapse Prevention: Use either the Relapse Triggers or the Relapse Phases & Warning Signs Discovery Cards decks to build a common language for your team to present to clients. Does your program utilize a consistent approach for relapse prevention or does each clinician have their own model? Is there a way to offer an evidence-based standardized approach that also acknowledges the clinical experience team members use?

Discovery Cards - Features for Engagement

Why Cards?

Cards are simple, familiar, and approachable. When we pick cards - whether they be emotions we're feeling, situations that trigger us, or defense mechanisms we use to protect our self - we begin to clarify what we're experiencing and thinking, see our behaviors in a new light, and become open to new ideas and possibilities.

The act of choosing cards cultivates ownership and an emotional connection with our own recovery and the actions needed to move forward toward change.

Why Models?

Models provide memorable visual symbols for complex concepts or sets of information and the relationships between them. The main purpose of a model is to provide a visual aid to facilitate learning, instruction, and retention. Two types that we use with the Discovery Cards are Contextual or Ontological Models and Process Models. Many of our Discovery Card topics categorize their information into color-coded categories to improve the learner’s ability to understand and relate to the content presented. This enables individuals to more quickly digest and process the information, apply it to their own experience or circumstance, discuss it with others, and take action based on their understanding.

Why Learning Styles?

Learning styles are the way that individuals absorb, process, comprehend, and retain information. The Discovery Cards have been designed to address a full range of learning styles including visual, kinesthetic, auditory, verbal, and logical. They’ve also been structured to be effective in a variety of settings; group, one-on-one, in-person, virtual, or remote. The more different learning approaches that can be incorporated, the more individuals will learn, retain, process, and share with others. This in turn helps them make healthier choices, take action, and make changes today and in the future.

Questions to Explore

Thinking about your own practice, program, or organization:

How has your effectiveness been impacted by social distancing measures?
What barriers or obstacles are you encountering as you introduce to virtual/remote/telehealth operations?
Are your clients and staff as engaged as they could be during this period?
What can you learn to increase your own skills and effectiveness in working virtually?
How can you implement new virtual practices to increase the engagement and learning of the clients you serve?

R1 Learning would be happy to discuss how we may be able to help.

Lastly, we hope that you, your family, friends, and coworkers are healthy and safe during this challenging time. That is most important. Know that we are here and available to address your training and engagement needs when you are ready. Thank you for your interest in our work and being part of our R1 community. Please take a moment and do the following:

1. Share this blog post with others. (Thank you!) 

2. Start a conversation with your team. Bring this information to your next team meeting or share it with your supervisor. Change starts in conversations. Good luck! Let us know how it goes. 

3. Visit www.R1LEARNING.com to learn more about R1, the R1 Learning System, our Discovery Cards, and how we’re creating engaging learning experiences through self-discovery. 

Guest UserMarch 25, 2020