LEAD-style case management is the heart and soul of this intervention, a “golden thread” to form trusting relationships with people for whom standard models of care just aren’t effective, helping participants navigate systems to foster their stabilization and progress. Rather than operating primarily in offices, LEAD case managers meet participants where they are: physically, mentally, and emotionally. Based on harm reduction principles, LEAD’s client-driven case management is flexible, adaptive, and patient.
This intensive, noncoercive, community-based approach represents an intentional reorientation away from clinical systems and expectations that can pose barriers for the people LEAD is designed to serve.
Stages of Change
Reducing harmful behaviors requires committed and ongoing effort, as anyone who’s ever made a new year’s resolution can tell you. People typically do not change behaviors quickly and decisively; rather, they may take two steps forward and then stumble back. The Stages of Change model (also called the Transtheoretical Model) recognizes that the progression towards change is not linear and fixed; that it must be internally motivated; that ambivalence to change is real and meaningful; and that sustained commitment is enhanced by patient, persistent, non-coercive support.
LEAD’s commitment to reducing harmful behaviors reflects this understanding. Rather than imposing external goals or timelines, LEAD focuses on supporting people on this sometimes bumpy road. Thus, people cannot “fail out” of LEAD: Once referred and enrolled, participants are not required to comply with a fixed schedule or timelines. Sites may decide to categorize participants as “active” or “inactive,” but participants are not removed from LEAD for failure to achieve or sustain a certain goal.
LEAD recognizes that the Stages of Change theory is also relevant to the development of positive new behaviors among all of LEAD’s stakeholders, whether high-level decision-makers, direct-service staff, reform advocates, or community members. In LEAD, everybody is encouraged to assess and reduce harmful attitudes, beliefs, policies, or actions.
Motivational Interviewing (MI) is a foundational technique for LEAD. An evidence-based approach to supporting positive behavior change, MI is a client-centered, collaborative style of communication designed to help people identify and achieve their goals by eliciting and exploring their own reasons for change.
Deploying a guiding (not directive) style of communication, MI is particularly useful in working with people who are not yet thinking about change, are ambivalent about change, or are not confident in their capacity to change. Unlike many approaches that tend to increase client resistance, MI is effective in decreasing resistance and thus enhancing a person’s willingness to change.
In LEAD sites, all client-facing staff should be trained in MI theory and practices, and all partners should be trained in its theory, principles, and implications.