conflict resolution & de-escalation...conflict resolution & de-escalation katie robbins...
TRANSCRIPT
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Conflict Resolution& De-Escalation
Katie Robbins Case, MSW, LISW
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Background:
➔ Medical Social Work(Home Health, Hospice, Inpatient, Outpatient)
➔ Crisis Intervention (ASAP program through Heartland Family Service)
➔ Outpatient Mental Health Therapist
…………………………………………………………………………
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Trauma Informed Care➔Meeting patients/clients where they are
◆ Most people we work with have/are experiencing some sort of crisis
➔Everyone experiences trauma in different ways◆ Their reality is what matters◆ Join with them, validate their experience
➔Empathy, Empathy, Empathy◆ Save judgement, even if you think they are attention seeking!
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Example:
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Example:
The Medical Issues
➔ Fractures◆ Neck, femur, tibia, pelvis,
shoulder, humerus, ribs➔ Three small brain bleeds
◆ Lots of confusion and agitation
➔ Breathing issues◆ Hypoxia
➔ Bleeding stress ulcers◆ Emergent surgery to clip
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Example:
Psycho Social Issues
➔ Sioux City, SD ◆ 8 hours away◆ Expenses (food, lodging
etc)◆ Loss of income
➔ Insurance was out of network◆ $20,000 deductible
➔ Lack of sleep (in the hospital for 16+ hours/day)
➔ Preparing for a wheelchair accessible home
➔ Lack of communication from physicians◆ No clear direction for
care
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Example:
The Conflict
➔ To intubate or not.⧫ Bipap issues, swelling,
size, fractures⧫ Continued confusion,
hypoxia
➔ Family meeting◆ Have a clear plan,◆ Ensure his wishes are
being met without causing more harm
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Example:
➔ The family◆ Nurse, Medical social
worker◆ Tired, scared, stressed,
frustrated◆ Informed and always in
the room...
➔ The Team◆ Busy◆ Disgruntled family to
deal with◆ Tricky patient with
LOTS of issues
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Example:
Helpful
➔ Listening ➔ Patience➔ Explaining ➔ Validating
Not Helpful
➔ Staff putting MD’s down➔ Not following through➔ Defensive➔ Belittling
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All better!
And no more motorcycles :)
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How do your experiences influence your work with clients/patients?
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Dysfunctional Conflict Management Styles
➔We learn how to deal with conflict from our families◆ Yelling◆ Violence What did you ◆ Passive Aggressive learn growing up?◆ Ignore/Bury issues◆ Accusing◆ Winner and a Loser
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Dysfunctional Conflict Management Styles
➔Everyone learns some bad habits➔Big emotions = Big reactions
◆ Takes more effort to control◆ What happens when a client/patient displays
your own dysfunctional style?
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Dysfunctional Conflict Management Styles
What happens when you feel activated?
➔Notice your emotional state◆ “Why am I feeling this way?”
➔Use your own grounding skills (more on that soon)➔Take a break/ask for help➔Practice and learn what works for you
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Dysfunctional Conflict Management Styles
➔Emotional Control = Situational Control◆ Think more clearly◆ Listen better◆ Observe body language◆ Unbiased/neutral◆ Offer empathy and patience
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Crisis/Conflict Intervention & Mediation
Partner with PoliceWorking in the Community
Individuals in Mental Health CrisisYouth/ families having severe, negative behaviors
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Example
➔ Ran away from home➔ Police brought her back➔ Lots of yelling, slamming doors
➔ 17 year old female➔ Fighting with parents➔ “Spoiled brat”
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Example
Professional Assumptions:
➔ Embarrassment (police and a therapist are in your house)◆ Neighbors are usually curious…
➔ Defensive (lots of blaming)◆ Want to be ‘right’ in front of this audience
➔ Scared (aren’t sure what to expect)◆ May get a citation
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Example
Where should we start?
Spoke to each individually*Why is this helpful?
➔ Allows time to cool down➔ Each person feels heard and
validated➔ Able to control the situation
more effectively➔ Builds quick rapport and
trust➔ Can avoid taking sides and
focus on compromise
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Detour
Identify:
➔ Does this person need to be grounded to participate?◆ This is as much for your
safety as theirs➔ Nonverbals that tell us
someone is very dysregulated
➔ Red face, clenched fists, thousand yard stare, fidgety, tension in the face, uncontrollable crying, shallow quick breaths, etc.
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Detour
Ideas for Grounding Clients:
➔ Deep Breaths (Box/Belly Breathing)➔ Tapping (Butterfly hug)➔ Focusing (Find a color in the room, counting)➔ Muscle tightening and releasing➔ Guided Relaxation
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Example
Client’s Concerns:
➔ Felt her parents are too strict ➔ Wants more independence/ freedom➔ Very defensive➔ Feels she is held to a higher standard of behavior than siblings
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Example
Family Mediation:
➔ Parents are still frustrated, but calm➔ Focus on 1 or 2 issues, can’t fix them all
in one go➔ Redirect when noticing defensiveness➔ Identify primary needs➔ Teach better ways to ask for your needs➔ Compromise!
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Example
Family Mediation:
➔ Just the beginning of a more successful relationship◆ Never “fix” it on the first try
➔ Correct poor communication in the moment➔ Be ok with interrupting and staying on task
◆ Use the one on one time to listen and let them vent➔ Goal is to be able to walk away knowing everyone is “ok”
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Example
People are unpredictable. Sometimes it’s the clients, sometimes it’s staff.
➔ Officer was activated, very upset➔ Gave the client a good and unneeded ‘scolding’
Cursing, yelling, belittling, name calling◆ Essentially, undid all the work I did for calmness, emotional
regulation, and compromise.
Surprise! Did you think it would be that easy?!
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Example
➔ Client is crying➔ Parents are speechless➔ I feel completely out of control of the situation
◆ Officer said (several times) I was too soft and ‘touchy feely’➔ Officers walk out of the house immediately
◆ I am required to have officers present and they just left…
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Example
➔ Now I’m frustrated and not feeling so confident◆ Sometimes managing our own feelings can be more
challenging◆ Remember the importance of self-awareness and practicing
skills to keep your baggage in check➔ Sometimes it just does not go as well as you want it to, keep at it!➔ In the end, everyone was fine.
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De Escalation
➔ Goal is to avoid escalation whenever possible◆ Use nonverbal cues◆ Grounding techniques◆ Validation and Acceptance◆ Patience and Empathy◆ Allow for client self determination
● Don’t push too hard, take a break if needed
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De Escalation
What to do when blindsided!➔ Try to move to a quieter/private space➔ Try not to react to behaviors and remain
as neutral as possible➔ Keep eye contact and stay attentive➔ Stay calm, don’t match their intensity or volume➔ Use direct commands but offer choice
(‘We can’t fix this until you feel calmer so what do you want to do? Deep breaths or go for a walk?’)
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Questions?
Comments?