Behavioral Health - Key Activity 13


Optimize Patient Engagement and Activation


This key activity involves the following elements of person-centered population-based care: operationalize clinical guidelines; proactive patient outreach and engagement; care coordination; behavioral health integration; address social needs.


This activity focuses on partnering with patients to foster engagement in care and health-promoting behaviors. Person-centered engagement methods are founded in the dignity of each individual to make their own decisions and the dual recognition that care goals are more likely to hold meaning when they are aligned with a person’s life goals and health outcomes are shaped by everyday behaviors. This activity includes shared decision-making, self-management support activities, and leveraging technology and other approaches to increase self-efficacy.

Patient activation supports patients to engage in behavioral healthcare and to positively shape the myriad daily behaviors that impact their health. Even with adequate and integrated capacity to care for behavioral health needs, much of the work of patient recovery happens outside of the clinic. The motivation and ability of individual patients to engage in care and make positive changes are essential to their treatment and recovery from an ongoing behavioral health condition.

Evidence increasingly supports self-management strategies for those living with mental illness.[1] As with chronic illness self-management, self-management support for mental health aims for the patient to develop skills to co-design and adhere to the action plan, regularly monitor changes in symptoms, adopt healthy life habits, communicate effectively with health professionals and their support network, and limit situations that can trigger new episodes. The underpinning of self-management support is the value of the dignity of choice, including a watchful waiting approach, making space for patients who opt out of treatment in such a way that they understand that they are welcome to reengage when they are ready.

Co-designing patient activation approaches to ensure that they are tailored to patient preferences, needs and assets can support people who had previously felt disconnected to the practice’s services to engage in care. Self-management supports for patients and their families are an essential part of a patient-first orientation to care that incorporates the realities of their lived experience.

Likewise, engaging patients of diverse communities in focus groups or patient and family advisory councils (PFACs) to co-develop messages and communication strategies can help to ensure the needs and preferences of specific communities of focus are communicated with sensitivity.

Developing workflows and clinical content within the EHR to support self-management goal setting and follow-up are foundational to this effort. In addition, the ability to develop a shared care plan affords all members of the care team the opportunity to support patient activation.

Care team communication tools, such as messaging apps, allow for engagement across the care team to support collaboration.

Action steps and roles

1. Cultivate a trusting and engaging environment where patients feel comfortable in accessing care.

Suggested team member(s) responsible: Leadership with IBH team.

A variety of ongoing training and skill development will support the care team in providing a welcoming environment to all patients:

  • Everyone in the practice has a role in welcoming patients into care, so the full complement of staff needs to be trained in trauma-informed principles of care. See the resource: Trauma-Informed Population Health Management.
  • Implement cultural humility training to address biases and promote equitable care. More about this is provided in Key Activity 6: Expand Access to Integrated Care.
  • Care team staff should also have training in self-management support and motivational interviewing (see below).

Displaying posters, pamphlets and other materials in the waiting room is an effective way to provide health education,[2] elicit patient engagement with behavioral healthcare, and assure patients of nonjudgement. Additionally, staff can wear lanyard buttons or badge stickers with messages, such as We ask because we care, to normalize universal screening. Some resources to consider:

Consumer advisory boards are a wonderful resource and can be effective partners to surface potential change ideas to enhance the practice’s welcoming nature, for example, by accomplishing clinic walk-throughs designed to look for opportunities to boost the welcoming nature of the physical space and limit negative experiences. For going deeper in developing an environment for supporting patient activation, consider sponsoring peer groups and group visits to foster peer engagement and support.

2. Train the care team in key self-management support skills.

Suggested team member(s) responsible: Leadership.

Some key self-management support techniques include the ask-tell-ask communication technique, motivational interviewing, person-centered goal-setting,[3] and the therapeutic alliance.

Resources for developing self-management support skills include:


3. Develop team-based approaches to foster patient engagement and self-management.

Suggested team member(s) responsible: Clinic leadership, clinical champion.

In some practices, a social worker is trained to conduct the more time-intensive initial goal setting, and senior clinicians will review progress on patient goals during the visit. In other practices, peer support specialists or upskilled community health workers or medical assistants may provide behavioral health support. Your practice may decide to focus self-management in one patient subpopulation, and this will influence who is best suited to complete the tasks.

Regardless of your design, it will be important to establish clinic visit workflows that coordinate self-management support interactions that take full advantage of the skills of all members of the care team, technology, and other resources available to patients.

Tip: Case-rounding is integral to a team-based approach for supporting patient engagement. It is a mechanism to enable the team to have a shared understanding of patients’ action plans and can support care teams to collaborate around patient care.

4. Employ interview techniques that support partnering with patients, including identifying self-management goals that align with their preferences and building on their coping strategies.

Suggested team member(s) responsible: Integrated care team.

Below are steps for providing self-management support around a shared care plan modeled on the OARS approach common in motivational interviewing:[4]

  • Ask open-ended questions: Ask broad questions that allow patients the maximum flexibility to respond without fear of a right or wrong answer. It can be as simple as, “What's been going on with you since we last met?”
  • Offer affirmations: Celebrate patients’ accomplishments and offer empathy for their struggles.
  • Practice reflective listening: When practicing reflective listening, patients are able to express their thoughts and then that information, if shared back with them with the purpose of eliciting conversation, helps them arrive at an idea for change.
  • Summarize the conversation: Recap what the patient has said, calling attention to the salient elements of the discussion, and allow the patient to correct any misunderstandings and add anything that was missed.


5. Leverage technology to support and document the development of a shared care plan.

Many EHRs have a module that supports the documentation of a shared care plan template. In the absence of using this type of module, patient self-management plans can be typed into the office visit summary and shared at the end of the visit.

Create a vetted list of condition-specific online or print resources that can be shared with patients of different ages and levels of health literacy. Some resources to start with:

  • NIMH provides self-care resources around managing stress, anxiety, and when to seek professional health.
  • Resources and posters linked in step one above.

For going deeper in this area, consider how telemedicine, remote patient monitoring, wearables, and new potentially artificial intelligence (AI) tools might supplement patients’ self-management ability. Consider both the health center’s capabilities and each patient’s ease with technology as well as whether the intervention is considered an emerging, promising or evidence-based practice. One such example of the use of technology is the Los Angeles County Office of Education (LACOE) partnership with K-12 public schools and health plans to offer a free third-party mental health telehealth service for students.


  1. Houle, J., Gascon-Depatie, M., Bélanger-Dumontier, G., & Cardinal, C. (2013). Depression self-management support: A systematic review. Patient Education and Counseling, 91(3), 271–279. 
  2. Moerenhout T, Borgermans L, Schol S, Vansintejan J, Van De Vijver E, Devroey D. Patient health information materials in waiting rooms of family physicians: do patients care? Patient preference and adherence [Internet]. 2013 Jun 4;7:489–97. Available from:  
  3. Self-Management Support | Agency for Healthcare Research and Quality [Internet]. Available from:  
  4. Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change, 2nd ed. New York: Guilford Press; 2002.