The concept of pretreatment was first used in the context of substance abuse, and the engagement and harm minimisation strategies used by the treatment agencies in this field.

Extending and developing the ideas in homelessness outreach work has largely been the work of Jay Levy, a social worker in the US. In his many writings and interviews, Jay spells out in very practical ways what we can see as the core skills of engagement, in interactions with individuals.

As developed and articulated by Levy, pretreatment has five key principles, running throughout all engagement work, which he identifies as:

• promoting safety
• forming a relationship
• developing a common language
• facilitating and supporting change
• taking into account cultural and 'ecological' considerations.

For the press release to Jay's latest (2021) workbook, and links to the publishers to purchase, see HERE

In a video interview (see opposite column for links) Levy himself has also described the essence of pretreatment as :

1. One: to get where the client is at.
2. Two:  to always ask ourselves, 'how do our words and actions resonate in the client’s world?” and
3. Three: to really understand that the engagement relationship process, the foundation of our working well, are skills and interventions that are required for common language development, as the main tools ....." 

(Levy 2014).

This stress on attention to language underlies all of Levy's writings, which use narrative to illustrate his key points.

These ideas are especially valuable in outreach work, which is the main focus of Levy's own work in Western Massachusetts. But Levy's REACH team there continues to work with their clients, through the whole process of settling into a new home and work.

The engagement skills and principles that pretreatment promotes are applicable across the whole range of services, including in settings where we may have some control over other aspects of the services (such as the built environment) to assist in the work of forming constructive relationships.

In one of the more recent books, Cross-Cultural dialogues', co-editors and authors Jay Levy and Robin Johnson develop the suggestion that there is a dialogue to be had between cultures, not just between the US and the UK, but also between the whole 'world' of services and the 'cultures' of each services. The task of the worker is then to translate between these languages.

Pretreatment principles can be used by workers from any discipline - social workers, psychologists, support workers - all those  who need to focus on engagement with those not necessarily keen or comfortable with engaging with services.

See for example John Conolly's chapter on Pretreatment `Therapy, in' Pretreatment across multiple fields in practice' ~Levy's latest book of edited essays, with US and UK authors  (LINK COMING SOON) ; or Rhian Mason's excellent introduction to Pretreatment, for the Assistant and Trainee Psychologists' Network:

Also Ray Middleton's introduction to Pretreatment (below)

Pretreatment focusses first on forming a relationship with the (potential) client, through finding, negotiating  or constructing what Levy calls a common language; that is, a way to describe the situation and the possibilities that both worker and client are at home with.  (That may also mean finding a language that connects the client with other services, and eligibility for benefits.)

Only then can the worker look to facilitating and supporting any possible change; always promoting safety especially as a central issue for the homeless client. Levy also stresses the need for bearing in mind a range of other, cultural or ‘ecological’ considerations, by which he means an acute awareness of how the client is situated and lodged in their world - the 'ecology' of their lives, beliefs and aspirations, as they see them

Further reading

See Jay Levy's own website for a wide range of material on pretreatment: HERE

For Robin Johnson's account of how Pretreatment and PIEs for together, see:  Pretreatment - PIEs in the micro-social world : HERE

PIElink pages on Outreach, Pathways, services without buildings : HERE

See also:

Jay Levy in conversation : HERE

Cross-cultural dialogues on homelessness on the PIElink:  HERE

Jay's presentation at the Pathways conference, London 2022 : HERE

NB: Westminster homelessness services commissioner Victoria Aseervatham's Top tips for commissioners of services Jay's work as one of her inspirations:. :HERE

By permission of the author, we also have three full chapters from Jay Levy's recent books, re-edited for the web:

"Entering the House of Language: Andrew's narrative' from "Homeless Narratives and Pretreatment Pathways; from Words to Housing"

'The Challenges of Helping Homeless Couples: Janice and Michael's narrative' from "Pretreatment Guide for Homeless Outreach & Housing First"

"Making meaning; the art of common language construction" from  "Pretreatment Guide for Homeless Outreach & Housing First"

See also:

Book review  by Lynn Vickery of "Pretreatment Guide for Homeless Outreach & Housing First" (from J. Housing Care and Support)

Editorial comment Robin Johnson (from J. Housing Care and Support)