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 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.
These ideas are especially valuable in outreach work. But the engagement skills that it promotes are applicable across the whole range of services, including in settings where we can use many other aspects of the services (such as the built environment) to assist in the work of forming constructive relationships.
NB: 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.
As developed and articulated by Jay Levy, pretreatment has a number of key principles, which he identifies as:
- promoting safety
- forming a relationship
- developing a common language
- facilitating and supporting change
- taking into account cultural and 'ecological' considerations.
To then unpack that a little, pre-treatment in outreach work focusses first on forming a relationship with the (potential) client, through finding, negotiating or constructing what Levy calls a common language, a way to describe the situation and the possibilities that both worker and client are at home with - and 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; and bearing in mind a range of other, cultural or ‘ecological’ considerations, by which Levy means an acute awareness of how the client is situated and lodged in their world, with their own concerns.
However, if from that it might appear that the 5 key elements of Pretreatment follow in sequence, a staged engagement, this is not so. These are all simultaneous processes to take into account continuously in our work, and, for example, in ongoing assessment.
In a video interview (see opposite column for links) Levy himself has also described the essence of pretreatment as : "One: to get where the client is at. Two: to always ask ourselves, 'how do our words and actions resonate in the client’s world?” and 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.
See also the book review by Lynn Vickery for a quick summary; and the section from Robin Johnson's editorial comment in that issue of the J. Housing Care and Support journal itself, which comments both on the review of Levy's book, and how it may relate to other debates and discussions on new forms of creative engagement work, such as Trauma Informed Care, and the development of PIEs.
NB: In a recent interview with Dr Alan Chartock, on North East Public Radio, Chartock and Levy discuss the issue of how to respond when some members of the public, politicians and other funders, may say: "surely they have chosen to live like this?" Here Levy outlines very clearly the importance of finding common ground and common language with those who seem to reject the offers that mainstream society makes.
