Assessing the Evidence: What We Know About Outreach and Engagement

Many of us recognize the value in outreach and engagement, and we practice and promote it in our communities. But what defines it? How do we know what works? How do we know that our approach to outreach is consistent with other successful approaches? This evidence brief shares preliminary findings from HRC’s review of outreach and engagement.

How do you define outreach and engagement? What are the essential elements? Challenges? Let HRC know by “Adding a Comment” or start a discussion and chat with your peers!

When people use the terms “outreach” and “engagement,” they can mean many things. For some, outreach can mean “going out” into the waiting room of a shelter or clinic. For others, outreach takes place in the streets, in camps, and in abandoned buildings. Outreach can mean efforts to educate the community about available services or it can be a place where other services happen. Many view outreach as a service in itself – a process of building a personal connection that may play a role in helping a person improve his/her health status, housing situation, or social support network. “Engagement” most commonly means engagement in services or the process of building a trusting relationship.

What is clear is that there is no common agreement on how to define outreach and engagement. One of HRC’s strategic goals is to determine the evidence base for exemplary and promising practices in the homelessness field, and to support strategies for increasing the level of evidence and implementing these practices in real-life settings.

In 2007, HRC reviewed the evidence for outreach and engagement to determine what is known about the practice. Below are the common themes that emerged about outreach and engagement.

We encourage you to use these themes to educate program staff, funders and community members about the value of outreach and engagement, and how it works.

1.    Outreach is an interactive process between outreach workers and clients that involves repeated contact over a period of time, for as long as services are needed. Follow-up is essential to successful outreach and engagement. The process involves time and patience.

2.    Outreach is many things: a location, a service, and a step along the way. Outreach can be understood as many different things. Essentially, it “seeks to establish a personal connection that provides the spark for the journey back to a vital and dignified life” (Bassuk, 1994, p. 10-3).

3.    It is the job of the outreach workers to meet people where they are (literally, judgmentally, metaphorically). Outreach workers should try to see from the client’s point of view. Literally, they should meet people in their neighborhoods and bring services to them, rather than expect them to visit a service agency for help.

4.    Outreach and engagement is designed to treat the whole person. Assessment and supports for medical and mental health issues are just as important as teaching life skills to emphasize that people can do better for themselves.

5.    Respect for the client is critical. Outreach services should be person-centered and should help clients to feel encouraged and hopeful about their futures.

6.    Relationship-building is of utmost importance. Relationships should be therapeutic. It is important to give it time and get to know people. Outreach allows the time to build trusting communication in order to create these relationships.

7.    Meeting basic needs is an important component of outreach. Helping people to secure food, clothing, shelter and housing builds a strong foundation for the relationship.

8.    Teams and networks are critical to successful outreach. Teams with knowledge of mental health and substance use are needed during days and evenings. These teams should be connected with other programs, and help to bridge the gaps between service systems.

9.    Flexibility and creativity are essential for effective outreach. Clinicians that are members of outreach teams may use creative, non-traditional approaches to treatment. This might include getting to know clients’ daily activities and using this information to engage them in ongoing, meaningful ways.

10.    Coordination of services is a key function of outreach. Outreach and engagement services should be connected to other community services. Linking clients to a network of services helps clients to develop a sense of personal control.

11.    Community education is one responsibility of outreach workers. The efforts of outreach workers can only go so far if the community does not have adequate resources or attitudes to support clients. Outreach teams can help by providing consultation, education, training, and referrals.

12.    It is important to involve consumers in outreach. Outreach programs are successful when they use consumers as outreach workers. They bring knowledge and lived experience that are extremely valuable to people who may be unsure about accepting treatment and building relationships with service agencies.

13.    Safety, boundaries, and ethics are primary concerns for outreach teams. Workers must constantly be concerned with safety and judge each situation. It is important to maintain boundaries with clients – do not socialize outside or work hours, and do not give or accept gifts.

14.    Outreach programs should be designed to serve people who have difficulty accessing services. People who are homeless and experiencing mental illness easily fall through the cracks because they may be harder to engage in services. The goal of outreach is to reach people who would otherwise not be reached.

15.    The end goal is to integrate people into the community. Outreach can invite people into an empowering community. Many outreach efforts teach life skills, job training, and help those they serve learn to function independently.

References (Recent, Selected):

Bassuk, E.L. (1994). Community care for homeless clients with mental illness, substance abuse, or dual diagnosis. Newton, MA: The Better Homes Fund.

Burt, M.R., Hedderson, J., Zweig, J., Ortiz, M.J., Aron-Turnham, L., & Johnson, S.M. (2004). Strategies for Reducing Chronic Street Homelessness. Washington, DC: U.S. Department of Housing and Urban Development, and The Office of Policy Development and Research.

Erickson, S., & Page, J. (1999). To dance with grace: Outreach and engagement to persons on the street. In L.B. Fosburg, & D.L. Dennis (Eds.), Practical Lessons: The 1998 National Symposium on Homelessness Research. Washington, DC: U.S. Department of Housing and Urban Development and U.S Department of Health and Human Services.

Fisk, D., Rakfeldt, J., Heffernan, K., & Rowe, M. (1999). Outreach workers' experiences in a homeless outreach project: Issues of boundaries, ethics, and staff safety. Psychiatric Quarterly, 70(3), 231-246.

HCH Clinician's Network. (2000). Mental illness, chronic homelessness: An American disgrace. Healing Hands, 4(5).

HomeBase, the Center for Common Concerns. (2003). Outreach procedures and protocols manual for working with homeless adults. San Francisco, CA: Author.

Kraybill, K. (2002). Outreach to People Experiencing Homelessness: A Curriculum for Training Health Care for the Homeless Outreach Workers. Nashville, TN: National Health Care for the Homeless Council.

Morse, G.A., Calsyn, R.J., Miller, J., Rosenberg, P., West, L., & Gilliland, J. (1996). Outreach to homeless mentally ill people: Conceptual and clinical considerations. Community Mental Health Journal, 32(3), 261-274.

Ng, A., & McQuiston, H. (2004). Outreach to the homeless: Craft, science, and future implications. Journal of Psychiatric Practice, 10(2), 95-105.

Rowe, M., Fisk, D., Frey, J., & Davidson, L. (2002). Engaging persons with substance use disorders: Lessons from homeless outreach. Administration and Policy in Mental Health, 29(3), 263-273.

Rowe, M., Hoge, M.A., & Fisk, D. (1998). Services for mentally ill homeless persons: Street-level integration. American Journal of Orthopsychiatry, 68(3), 490-496.

Tsemberis, S., & Elfenbein, C. (1999). A perspective on voluntary and involuntary outreach services for the homeless mentally ill. New Directions for Mental Health Service, 82, 9-19.

Wasmer, D. (1998). Engagement of Persons Who Are Homeless and Have Serious Mental Illness: An Overview of the Literature and Review of Practices by Eight Successful Programs. Chicago, IL: De Paul University.

Publication Date: 
Rockville, MD, USA