The core skills of engagement : pre-treatment

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. These ideas are especially valuable in outreach work. But the engagement skills that it promotes are applicable across the whole range of services.

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.

Further background

For the press release, and links to the publishers to purchase, see HERE


American PIE : HERE


All PIElink forums 

Pretreatment in Action - PIElink forum : HERE


Further reading

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

See also the whole section on Cross-cultural dialogues on homelessness,  HERE on the PIElink.


But, by permission of the author, we 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"

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)


An interview with Jay Levy, talking on his work, on US TV.

Homeless engagement: 5 principles of pretreatment: Jay Levy in discussion with Ray Middleton.

North East Public Radio interview with Dr Alan Chartock

Matt Bennett: Connecting paradigms: Talking trauma across the Atlantic with Jay Levy and Robin Johnson  (Episode 55) HERE

Finally, Victoria Aseervatham's  video of her Top tips for commissioners of services cites Jay's work as one of her inspirations.