Participants will identify the benefits of sustained client engagement in substance use treatment and examine risk factors that contribute to disengagement at the individual, social, and systemic levels. They will also apply evidence-based care management strategies to prevent and respond to disengagement, with a focus on strengthening relationships, addressing social drivers of health, and supporting re-engagement.

Agenda:

1. Introduction
2. Background
   1. Definition of client engagement
   2. Treatment gap: 6.1M people with OUD in 2022; ~87% not receiving MOUD; low program completion rates
   3. Care manager's role: needs assessment, care planning, outreach, resource linkage, care transitions
3. Benefits of Engagement
   1. Survival: MOUD retention reduces overdose mortality (59% reduction with methadone; 38% with buprenorphine)
   2. Improved life outcomes: abstinence, fewer ED visits, fewer arrests
   3. Reduced system costs: care coordination lowers unnecessary acute care
   4. Recovery capital: outreach, peer support, and wraparound services
   5. Discussion question: reflect on a client you helped stay engaged
4. Recognizing the Risk of Disengagement
   1. Early warning signs: missed appointments, no response to outreach, housing instability, crisis escalation, hopelessness, insurance gaps
   2. Individual-level factors: age, motivation, co-occurring mental health conditions, internalized stigma
   3. Relational & social factors: weak therapeutic relationship, provider stigma, social isolation
   4. Systemic & structural factors: rigid requirements, fragmented care, limited MOUD access
   5. Ambivalence: visible behaviors (minimizing, deflecting, disappearing) vs. hidden drivers (mistrust, pessimism)
   6. Coercion: perceived coercion drives poor outcomes; respectful, autonomy-supportive approaches improve retention
   7. SDOH as disengagement drivers: housing, transportation, economic instability, justice involvement, isolation, food insecurity
   8. SDOH + stigma: structural, provider, and self-stigma compound each other
5. Strategies to Prevent and Address Disengagement
   1. Addressing SDOH: screen at every contact, document barriers, connect to community resources, advocate, use flexible outreach
   2. Ongoing needs assessments & care plans: validated tools, individualized plans reflecting goals, barriers, and strengths
   3. Protective factors
   4. Proactive outreach: follow up on no-shows within 24–48 hours, use EHR flags, engage trusted supports
   5. Reengagement: act fast, nonjudgmental outreach, update care plan, ensure naloxone and safety planning
6. Key Takeaways
   1. Disengagement is clinical, driven by distress, stigma, and social barriers
   2. The relationship determines the outcome, respect and autonomy matter
   3. Address SDOH, not just diagnosis, survival needs compete with care
   4. First 30 days are highest risk; proactive outreach is the primary strategy
   5. Screen continuously; care plans must stay current
   6. Resistance = ambivalence; respond with curiosity, not confrontation
7. Latterman Family Health Center COE Presentation
   1. Foundation: Philosophy & Relationships
      1. Clients self-select into care; start with their goals and values
      2. Engagement is built through trust and human connection
      3. Prioritize relationship-building over compliance
      4. Meeting clients at their stage of change
   2. Access & Engagement Strategies
      1. Flexible, low-barrier care (texting, reminders, drop-in options)
      2. Meet clients where they are (clinic, home, community)
      3. Consistent outreach—even when clients are inconsistent
      4. Engagement goes beyond attendance
   3. Addressing Needs Holistically (SDOH)
      1. Identify and address transportation, housing, food needs early
      2. Integrate SDOH into care planning
      3. Use partnerships and on-site resources
      4. Adapt care (e.g., harm reduction, early MOUD access)
   4. Preventing & Responding to Disengagement
      1. Recognize early warning signs (missed visits, reduced communication)
      2. Respond quickly with proactive, multi-method outreach
      3. Maintain a non-judgmental, supportive approach
      4. Normalize disengagement and celebrate re-engagement
8. Discussion