This article is part of the MiiWrap Institute’s series, Closing the Sustainability Gap: Building Human Services That Create Change Beyond Services. Start with Part 1 | Part 2 of 6
In human services, engagement is often treated as the beginning of the intervention. First, we need to get the person engaged. Then we can begin the real work. We hear this language in many forms:
The assumption is understandable. If someone is not participating, it is difficult to provide a service effectively. But there is another way to think about engagement. What if engagement is not simply the condition that has to exist before meaningful work can begin? What if engagement is part of the work itself? And more importantly:
What if the way we engage people is one of the mechanisms through which meaningful and sustainable change becomes possible?
Because if engagement is simply a prerequisite for intervention, our job is to get people to participate in the intervention we have designed. But if engagement is part of the mechanism of change, our job becomes different. We are helping people become active participants in determining what they want, why it matters, what they are willing to do, what support they need, and how they will respond when circumstances change. That is a much more consequential understanding of engagement.
Human service organizations need practical ways to know whether people are participating in services. Attendance, returning phone calls, completing assessments, and participating in meetings are all simple to measure things that have some importance to the overall process. But these behaviors are not the same thing as meaningful engagement.
Conversely, someone can question a recommendation, express ambivalence, disagree with professionals, or need considerable time before deciding what they want, and still be deeply engaged in the process of change.
This distinction is especially important in systems serving people with complex or intensive needs. The people entering these systems may not have chosen to be there. They may be responding to a crisis. They may have experienced previous interventions as controlling or ineffective. They may have legitimate reasons to distrust institutions. They may be overwhelmed by the number of professionals involved in their lives.
In some settings, participation is also shaped by legal, financial, or institutional requirements. Calling these people “unengaged” can obscure a much more important question: engaged in what?
Are we asking whether someone is participating in our process? Or are we asking whether they are becoming meaningfully involved in their own change? Those are not necessarily the same thing.
Research in child welfare, for example, has identified persistent concerns about engagement practices that rely on authority, coercion, bureaucracy, deficit-focused approaches, and limited participation by children and families. A scoping review of the literature concluded that improving outcomes requires a shift toward meaningful participation and stronger relationships between practitioners and families.
The distinction is not merely semantic. It changes what we think the practitioner is trying to accomplish.
Human services are relational work. Even when the intervention has a formal curriculum, treatment protocol, assessment process, or case plan, it is ultimately carried out through interactions between people.
That relationship does not guarantee a positive outcome. The evidence is more nuanced than that. But across several areas of behavioral health and human services, research has found meaningful associations between the quality of the working relationship and outcomes.
A 2018 meta-analysis of prospective studies involving children and adolescents found a small-to-moderate positive association between therapeutic alliance and treatment outcomes, although the strength of that relationship varied across contexts.
Research examining young people with anxiety and depression has similarly found that stronger working alliances are associated with outcomes such as positive coping, optimism, emotional regulation, self-esteem, and treatment adherence.
This does not mean that being nice, building rapport, or having a good relationship is enough. It means something more useful.
The interaction between practitioner and person is not separate from the intervention. It is part of the environment in which the intervention takes place.
That should matter to organizational leaders. Because if the relationship affects how people participate, respond, learn, make decisions, and act, then engagement cannot be treated solely as an individual characteristic. It is also something practitioners and organizations influence.
Consider two very different conversations.
In the first, a practitioner has identified several things the family needs to do. The practitioner explains the recommendations, answers questions, and asks the family to agree to the plan. The family says yes.
In the second, the practitioner works with the family to understand what they want to be different, what they believe is getting in the way, what they have already tried, what matters most to them, and what they believe might actually work. The practitioner brings expertise and recommendations into that conversation, but the family remains an active participant in determining direction.
Both interactions might produce a completed plan. But they are not creating the same conditions for change. The second approach gives the person a greater opportunity to develop something that cannot simply be provided by the practitioner: ownership.
This connects to a much larger body of research on motivation and self-determination.
Self-Determination Theory proposes that people are more likely to experience autonomous motivation when their needs for autonomy, competence, and relatedness are supported. Research across many settings has connected these conditions with more internalized forms of motivation, engagement, persistence, and well-being.
Research specifically examining social work relationships has begun applying this framework to family-serving practice as well. A realist synthesis examining the social worker-family relationship in Signs of Safety, for example, proposed that practices supporting autonomy, competence, and relatedness may create conditions for more autonomous motivation and more sustainable behavior change, while also emphasizing that these propositions require further empirical testing in child protection settings.
We should not turn a useful theory into a promise the evidence has not established. But the implication is important enough to take seriously: people are more likely to participate meaningfully in change when they experience themselves as participants in it.
This distinction becomes particularly important when services are working with people whose choices have consequences for safety, health, children, housing, legal involvement, or other significant areas of life. Supporting autonomy does not mean abandoning professional responsibility. It does not mean allowing people to make choices that professionals believe create unacceptable risk without discussion. It does not mean that every preference can be accommodated. And it does not mean practitioners stop bringing expertise, recommendations, boundaries, or accountability to the work.
Instead, it means recognizing the difference between supporting someone’s participation in change and trying to manufacture compliance with our preferred outcome. That distinction is central to Motivational Interviewing (MI).
MI is not simply a collection of communication techniques for persuading people to do something they are reluctant to do. Its underlying approach emphasizes collaboration, respect for autonomy, and eliciting people’s own reasons for change.
Research examining mechanisms of MI has found evidence suggesting that client change talk and intentions are associated with better outcomes, while therapist behaviors inconsistent with the MI approach are associated with poorer outcomes. At the same time, researchers have repeatedly noted that the mechanisms of MI are complex and that stronger causal research is still needed.
A later review and meta-analysis examining MI mechanisms in mental health populations found a favorable effect on engagement variables, while also noting substantial variation across studies.
The lesson is not that MI has proven that engagement causes every kind of positive outcome. The lesson is more practical: how practitioners interact with people can influence how people participate in the change process.
This is where organizational culture becomes important. If an organization defines engagement primarily as:
then practitioners will naturally learn to pursue those behaviors. And when a person does not comply, the organization may begin looking for ways to increase compliance. The language changes. We start talking about resistant clients, unmotivated families, poor follow-through, noncompliance, and lack of buy-in.
Sometimes those descriptions are accurate descriptions of what happened. But they may not explain why it happened. A more useful question is: what is the person’s lack of participation telling us about the conditions of the intervention?
That question does not assume that the practitioner or organization is at fault. It simply recognizes that behavior occurs in context.
All of these possibilities require different responses. The label “unengaged” tells us very little by itself.
This may be one of the most important shifts leaders can make. When engagement is understood as a mechanism of change, disengagement becomes something to learn from, not simply something to overcome. That means asking:
These questions do not eliminate professional responsibility. In fact, they improve it. They help practitioners distinguish between a person who is unwilling, a person who is uncertain, a person who does not understand, a person who feels powerless, a person who has lost hope, and a person who is actively rejecting an approach that does not fit.
Those are all very different situations. And they should not all receive the same interventions.
This brings us back to the sustainability question from Part 1. If the goal of human services is only to produce an outcome while professionals are present, then compliance may be sufficient. But if we are trying to create change that can continue after services recede, something else has to happen.
The person has to become increasingly able to participate in the process of navigating their own life. That requires more than receiving good advice. It requires opportunities to:
These are not simply outcomes that appear after the intervention has succeeded. They are processes through which sustainable change can develop. That is why engagement matters so much.
Engagement is not merely whether someone participates in the service. It is whether the person is becoming an increasingly active participant in the work of change.
This understanding requires a different conception of professional expertise. The practitioner still brings knowledge.
They still assess risk, understand interventions, coordinate resources, and provide structure, challenge, and accountability. But expertise is no longer defined primarily by how much the professional can do for the person. It includes how effectively the professional can help the person become more capable of doing what they can do for themselves.
That is a different skill set. It requires practitioners to know when to provide information and when to elicit the person’s thinking. When to recommend and when to explore. When to lead and when to step back. When to solve a problem and when to help someone develop the capacity to solve it. When to push for action and when to recognize ambivalence. When to coordinate support and when to strengthen the relationships that can eventually make professional coordination less necessary.
These distinctions are easy to describe. They are considerably harder to practice consistently. And that is why this is not simply a matter of telling practitioners to “engage families better.” It is a practice-development issue.
If engagement is part of the mechanism of change, organizations need to think carefully about what they are actually measuring.
Attendance, participation rates, retention, and completion rates are all useful. But none of these measures tells us whether people are developing ownership of the change process. Leaders should also be interested in questions such as:
Not every organization can measure all of these questions immediately. But leaders should be asking whether their current measures capture the kind of engagement they actually believe produces change. Because organizations tend to get what they measure.
For leaders working in complex human services systems, engagement can sometimes sound like a softer concern compared with safety, clinical outcomes, placement stability, fiscal performance, or compliance. It is not.
Engagement is connected to the basic question of who is doing the work of change. If professionals are doing most of the identifying, deciding, planning, problem-solving, motivating, coordinating, and evaluating, then the service may be highly effective while it is present.
But what happens when the professionals leave? This is the question that connects Part 2 back to the sustainability gap.
If the person has primarily learned to rely on professionals to solve problems, then the service may have unintentionally strengthened dependence on the service system.
If, instead, the person has had repeated opportunities to develop ownership, confidence, decision-making ability, problem-solving skills, supportive relationships, and knowledge of how to access resources, then the service may have contributed to something that lasts.
That does not mean people should not need services. It means that when greater capability is possible, the development of that capability should be part of the work.
This is one of the central ideas underlying the MiiWrap Practice Model. MiiWrap does not treat engagement as a preliminary step that practitioners complete before moving on to the “real” intervention.
Engagement is part of the intervention.
The relationship matters because it creates the conditions in which people can participate. Participation matters because it creates opportunities for ownership. Ownership matters because sustainable change cannot simply be imposed from outside. And the development of ownership, motivation, confidence, agency, skills, and supportive relationships is part of what allows progress to continue beyond formal services.
This is one reason the integration of Wraparound and Motivational Interviewing is consequential. Wraparound provides an individualized, team-supported structure for addressing complex needs. Motivational Interviewing contributes a relational approach to strengthening people’s own motivation, direction, and participation in change. MiiWrap brings these ideas together around a larger question:
How do we create the conditions in which people can become active participants in changes that they can sustain?
That is a different question from how do we get people to participate in our services? The difference may sound subtle. In practice, it changes almost everything.
Part 1 of this series asked: What should remain when services end?
Part 2 brings us one step closer to an answer. If sustainable change depends in part on what people are able to carry forward after formal intervention recedes, then we cannot treat people as passive recipients of services.
They have to be participants in the process through which change develops. That means engagement is not simply the doorway to the work. It is part of the work.
And if that is true, then the next question becomes unavoidable: What are we actually trying to build through that engagement?
That question takes us to the next part of this series.
In Part 3: The Real Outcome of Human Services Should Be Capability, Not Dependence
If engagement is part of the mechanism of change, then what should change actually produce? In Part 3, we will examine a more fundamental question for human service leaders: what are practitioners actually trying to change? Because connecting someone to services is not the same as helping them become more capable of navigating life. And those are very different outcomes.
Research & Further Reading
Caffrey, L., et al. (2022). Understanding the social worker–family relationship through self-determination theory: A realist synthesis of Signs of Safety. Child & Family Social Work.
McLeod, B. D. (2011). Relation of the alliance with outcomes in youth psychotherapy: A meta-analysis. Clinical Psychology Review, 31(4), 603–616.
Karver, M. S., et al. (2018). Meta-analysis of the prospective relation between alliance and outcome in child and adolescent psychotherapy. Psychotherapy, 55(4), 341–355.
Apodaca, T. R., & Longabaugh, R. (2009). Mechanisms of change in motivational interviewing: A review and preliminary evaluation of the evidence. Addiction, 104(5), 705–715.
Romano, M., et al. (2015). Evaluating the mechanisms of change in motivational interviewing in the treatment of mental health problems: A review and meta-analysis. Clinical Psychology Review, 38, 1–11.
Madsen, W. C., et al. (2018). Family engagement in the child welfare system: A scoping review. Children and Youth Services Review, 88, 598–607.
Lakhani, A., McDonald, D., & Zeeman, H. (2018). Perspectives of self-direction: A systematic review of key areas contributing to service users’ engagement and choice-making in self-directed disability services and supports. Health & Social Care in the Community, 26(3), 295–313.
Howard, J. L., Slemp, G. R., & Wang, X. (2025). Need support and need thwarting: A meta-analysis of autonomy, competence, and relatedness supportive and thwarting behaviors. Personality and Social Psychology Bulletin.
This article is part of the MiiWrap Institute’s series, Closing the Sustainability Gap: Building Human Services That Create Change Beyond Services. Start with Part 1...
This article is part of the MiiWrap Institute’s series, Closing the Sustainability Gap: Building Human Services That Create Change Beyond Services. [Start with Part 1]...
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