7. Refusal and Disappearance: Deciding What to Do

Converting the Resistant Client

Once you find the client, it is usually easy to schedule and conduct the interview. This is especially true when the clients are paid for participation and when they trust you. In some cases, however, locating is the easy part; convincing the resistant client to participate may take considerable effort. Some people are weary of the process, especially if this is the second or third contact. Others have changed their lives and don't want to be associated with anything from their past, or want to keep their new wives or husbands from finding out about previous lives. Others may have had negative experiences with a study or treatment program. Some may simply be distrustful of any "establishment" contact. It is important to remind these people that this is their opportunity to provide feedback (what they liked or didn't like about the program so that it can be improved the next time). Resistance falls into two categories: active refusal and passive refusal.

Active refusal. If a client tells you up front, "No, I do not want to participate" (an active refusal), try to ascertain why. Ask if they need more information about the study. Also, ask if they would like to speak to the study director about any concerns they might have. Is the client worried about confidentiality? If so, carefully explain your confidentiality procedures and the effort the staff takes to protect all clients' information. Explain how the Certificate of Confidentiality protects them (if you have one). Explain the importance of the study and how each person's opinions and experience are crucial to the outcome. If "no" is still the answer, ask the person to think about it and call if they change their mind. After a couple of months, write a letter restating the importance of participation. Maybe your client will change their mind and agree. Change of mind is particularly common for those who refused while in prison or jail. Contacting these clients after release may bring about a change of mind. Conversely, some clients resist participation while out of prison or jail, but may readily agree when contacted in jail or prison. If your study is well supported, you may be able to offer more money. This is usually the best incentive to secure participation. However, offering more money to some clients may have a negative effect since the word may get out and others will demand additional compensation for participation. This may be the case in small communities where many clients are likely to know one another.

Passive refusal. Passive refusals can be divided into three subcategories: (1) the repeated no-shows, (2) the evaders and (3) the "non-trusters." The first group consists of clients who schedule an interview but don't appear. They will not call to cancel and reschedule, but when they are contacted again, they readily set up a new appointment and no-show again and again. These clients may be extremely busy (i.e., working more than one job) or they may just be very disorganized. You may spend the time and effort to schedule over and over, but never get the interview. The key to obtaining a completed interview is to make it as easy as possible for the client to complete it. You may suggest meeting the client at home or some other place more convenient than your office. Also, instead of rescheduling no shows, once you contact the client on the phone, ask if you can come "right now" and meet the client wherever he or she is. An alternative is to leave the client alone for a while and try again a few weeks or months later. Sometimes, circumstances change and the client may be more able to keep their commitment.

The evaders never schedule an interview. They can be located, but they do not respond to calls or letters. If you call, they are never at home, or if they are at home they cannot schedule the interview at that time, but will ask you to call back later, at which time they are not available (either you repeatedly get an answering machine or a gatekeeper). If you do catch the client, you will again be told that he "cannot schedule, but if you call..." These instructions are repeated at each contact and you get the same result: They never schedule. Sometimes, a finder's fee is offered to a relative or friend. This may induce the client to call, as "nudging" is now coming from other directions as well as from you.

The above-mentioned passive refusals are the most frustrating because you are never quite sure if and when they can be converted. It is difficult to determine how persistently and frequently you should pursue a passive refusal. Too much pestering can easily turn a passive refusal into an active refusal who is lost forever. If you think this is about to occur, let the file "rest" for a while. Alternatively, have another tracker make contact, which may convert the passive refusal into a completed interview.

HINT: Refusals may be converted by offering additional cash or other incentives. Appealing to the individual client's importance to the program evaluation may also convince a reluctant client to change his mind. Create special letters stressing the importance of the program evaluation and tailor the letter to your client. Point out how the findings can help the client, his family, and the community.

The non-trusters are usually clients who are being contacted for the first time or who haven't been contacted for several years, and therefore don't know or have forgotten who you are. They are often in trouble with the law; they may be absconding from probation or parole, and will never let you know that your letters have reached them, fearing that it is a police trap. The good news is that they are usually only refusers until they know who you are and know that you can indeed be trusted. The bad news is that you may never get the chance to tell them.

It is best to contact these people in person, going to their homes, or finding them in jail or prison. Sometimes convincing a relative or friend to trust you may make the difference. Once they see that your interviewer is clearly not a parole/probation officer or child protective services worker, they are usually willing to complete the interview. Offering more money to this group will probably have an adverse effect, as it may appear to confirm for them that this is a scam.

CASE STUDY: A female client in a longitudinal study had been very elusive to the locators. Letters were returned, sometimes with a new address, sometimes not. No phone number was available for her. The DMV report showed no recent activity. Doorknocking produced no good leads. We had reached a dead end. One day, however, a check with the Department of Corrections found her to be incarcerated at a local state prison. She was contacted by mail, called us back, and readily agreed to the interview. In the prison, she told the interviewer how much she admired our tracking skills: "Nobody has been able to find me the way you guys have. No matter where I went, I got a letter." When she was asked why she had not responded to our correspondence before, she said that she had outstanding warrants and was convinced that it was her parole officer or police looking for her. However, once she was back in prison and still receiving our mail, she realized that we were not the Law, and thus felt safe to call. Once contact and trust were established, she readily agreed to be interviewed again in each of the next two years.

When to Take "No" for an Answer

How do you decide that a client is truly an absolute refusal? First, never take another person's word that someone is a refusal. You may get a relative on the phone who will say, "J.J. told me she is not interested." If you get that response, tell the person that you need to hear that from the client. A refusal from any other source is not acceptable. Here, then, are some guidelines for deciding to accept that a client is a refusal and should not be recontacted, at least not for a while.

• Client has firmly refused at least once, either in person or on the phone.
• Letters of appeal have gone unanswered.
• Phone calls and letters offering more money have been ignored.
• Client has been a no-show at least four times without canceling or re-scheduling. The client never initiates contact and doesn't show even if offered more money.
• The client stops taking your calls.

Even presented with one of the conditions listed above, always leave the door open for a client to change his or her mind, and always attempt one last time to convert a refuser just before the study is over. Circumstances may have changed for the client, making him or her more amenable to the interview. For example, some clients change their minds when they get incarcerated, or conversely, when they get released from jail or prison. The client's financial circumstances may be such that he or she now needs the money.

Before You Give Up

When should you stop looking for clients? Ideally, when all clients have been interviewed. (It is generally accepted that a follow-up rate of less than 80 percent is inadequate for proper statistical interpretation.) However, many study constraints may impede the follow-up rate that you want; these include time, budget, and staff capabilities. Before actually calling it quits, make sure you have exhausted all locating methods available to your project.

One consideration to make before you quit pertains to the workload of the study personnel. Many evaluation studies employ the same people to conduct the interviews and track and locate clients. This is probably the most cost-effective way. When a client is located in the field, the interview can be conducted on the spot. There are times, though, when the efforts of the dual-role staff is not enough. You may want to consider the following options if budget permits.

Assigning a primary tracker for the hardest to find cases. It may be helpful to assign one person to track the very-difficult-to-find clients. The person assigned to do this should be experienced, tenacious, inventive, enthusiastic, and knowledgeable about all tracking methods, and should also be comfortable doing street locating.

CASE STUDY: Doug, a seasoned tracking and locating coordinator, was assigned to work the "difficult-to-locate" section of the follow-up files. One client, a man with outstanding legal warrants in California, seemed to have disappeared. His last known date of contact was an arrest in Florida three years before. His parents had lived in Chicago, but could not be located there through phone or mail. Doug realized that many couples retire to Florida from the cold cities in the North. He called directory information in the city of the client's arrest and asked for the phone number and address of his parents. To his surprise, there they were, and their son lived across the street. He agreed to be interviewed on one of the study's nationwide interviewing trips.

Hard-to-find case conferences. Have a meeting in which staff bring the files of their hardest-to-find clients and discuss the process they have gone through with each case. Other staff may have suggestions for additional locating strategies. We have these meetings every two weeks or so and find them very useful.

Trade cases. If you do not already do this, try it now. Sometimes a fresh perspective can do wonders. Each tracker tends to rely on different resources, so trading cases can make a difference. Or, perhaps another tracker will have just the right touch with a client's grandmother and will be put in contact with your client.

In conclusion, all hard-to-locate clients should be tracked until the bitter end. Even if it seems that a client will never be found, continue to request credit bureau address updates every month or two; check the jail rosters and Department of Corrections lists regularly; send letters to all addresses; revisit neighborhoods where you might have had some leads. The bottom line is, don't give up until the study is over.