Editorial comment on Pre-treatment guide review (fragment)
Robin Johnson
From Housing Care and Support Vol 17.4
...... The fact remains that many service “users” – and especially those deemed hard to “engage”, may see their lives from quite other perspectives also takes us on to the issue of the actual skills entailed in engaging those who – perhaps from past experience - may now be the most reluctant to engage. It is customary publishing practice to place book reviews at the back of a journal; and sometimes they may get barely a mention in an editorial.
But there are times when the subject matter of a book is so germane to the issues in the published papers, that some comment really is needed, in the editorialising process. One such is Jay Levy's “Pre-treatment Guide for Homeless Outreach and Housing First”.
The issues that Levy addresses in this short book, reviewed here by Lynn Vickery, go to the heart of the issue - the centrality of trusting relationships; and here Levy stresses the power of narratives and the subtleties of engagement. Levy does not just assert, but shows by example the role of shared language in creating relationships.
These cameos accounts are not merely anecdotal, for educational purposes; this approach can also be deeply rooted in a fully elaborated theoretical background – in this case, linguistic analysis and social constructionism- and in turn this approach can start to form the foundations of a new intermediate level theoretical vocabulary of more immediate use to the pragmatist in frontline services.
Lynn Vickery's review also notes that this whole discourse is still carefully located within the framework of the approach known as Housing First – HF - which in recent years has amassed a very impressive body of evidence, so that it now it seems the predominant paradigm of research and policy in the United States.
In talking of “pre-treatment” as against treatment, and whilst stressing and clearly illuminating the personal baggage of many homeless people, and the need to address this with great care, Levy is careful not to take issue with the argument that “treatment” must wait. Nevertheless, what he is advocating is, by implication, not something utterly different, but on the same spectrum – a precursor.
For this, it is hard to disagree, if by that term “treatment” we mean those rather narrowly circumscribed interventions of conventional health and psychology services, whose evidence base for effectiveness is largely derived from a far more settled and willingly engaged population. But we know that demanding compliance with doubtfully appropriate treatments is in effect to operate an exclusion policy – and one for which we can then handily blame the “hard to engage” client.
As Vickery observes, there does seem a natural affinity and common purpose between greater recognition of the relationship skills in outreach work, and greater recognition of the necessary skills in building-based work, in hostels, refuges and foyers, such as we have been seeing in the UK with the growth of interest in creating more “psychologically informed environments”, or PIEs.
There is a clear need to bring together these two parallel or contrasting discourses of progressive practice, between the more established US focus in research on HF, and the more recent development, especially in the UK of interest in exactly how services such as hostels refuges etc CAN work constructively.
RJ Nov 2014