Embed Size (px)
Citation preview
Engaging Challenging Clients and Crisis Communication
Heather Sylvester, LCSW
August 11, 2020
DisclaimerThe National Adult Maltreatment Reporting System (NAMRS) and the Adult Protective Services Technical Assistance Resource Center (APS TARC) are a project of the U.S. Administration for Community Living, Administration on Aging, Department of Health and Human Services, administered by the WRMA, Inc. Contractor’s findings, conclusions, and points of view do not necessarily represent U.S. Administration for Community Living, Administration on Aging, Department of Health and Human Services official policy.
Adult Protective Services Technical Assistance Resource Center 2
About the APS TARCThe mission of the APS TARC is to enhance the effectiveness of state APS programs by:Supporting federal, state, and local partners’ use of data and analytics, Applying research and evaluation to practice, andEncouraging the use of innovative practices and strategies.
Adult Protective Services Technical Assistance Resource Center 3
Peer to Peer Calls
Adult Protective Services Technical Assistance Resource Center 4
Have you ever wished that you could tap into the expertise of other APS workers, supervisors or state administrators who are struggling with the same issues and concerns that you deal with daily? The APS TARC provides Peer to Peer calls for workers, supervisors and managers/state administrators.
Workers’ Call: The 2nd Wednesday of each month
Supervisors’ Call: The 3rd Wednesday of each month
Administrators’/Managers’ Call: The 4th Wednesday of each month
Register via the link sent out at the end of each month by the APS TARC or email us in order to receive the registration link!
APS & COVID-19https://apstarc.acl.gov/Information-Research/COVID-19.aspx
• Resource Information• Federal brief addressing:Personal SafetyContinuity of Operations
• Summary of State Program and Policy Responses to COVID-19
Adult Protective Services Technical Assistance Resource Center 5
Housekeeping• This session is being recorded and will be posted
online at a later date. • To ask a question or to make a comment, please use
the “Questions” box on your GoToWebinar Control Panel.
• If you have audio problems, we suggest closing the webinar and then logging back in. You must use your computer to listen to audio for this event.
Adult Protective Services Technical Assistance Resource Center 6
Quick Attendee PollWhich of the following do you identify the most with?Adult Protective Services ProfessionalOther Social Services ProfessionalMedical ProfessionalLegal ProfessionalOther
Adult Protective Services Technical Assistance Resource Center 7
Our Speaker
Adult Protective Services Technical Assistance Resource Center 8
Heather Sylvester, LCSWBehavioral Health Services SupervisorJefferson Wellness Center - Adult Full Service PartnershipRiverside University Health System, Behavioral Health
Agenda• Common challenges in engagement• LEAP interventions• Crisis definition• Crisis communication strategies
Why talk about engagement?• Engagement within the context of a therapeutic relationship is
defined as a point at which the consumer views treatment as a meaningful and important process
• Collaboration, cooperation, participation and “buy-in”
Jacobsen, Courtney A., "Social Workers Reflect on Engagement with Involuntary Clients" (2013).Master of Social Work Clinical Research Papers. Paper 198. http://sophia.stkate.edu/msw_papers/198
Why might it be difficult to engage a consumer?• Your approach
• Consumer does not want help
• Consumer receives secondary gains by refusing to buy-in to the
treatment
• Denial
• Anosognosia
Anosognosia• A neurologically based unawareness of disability
• Anosognosia is a symptom of schizophrenia NOT a coping mechanism
• 57-98% of individuals with schizophrenia experience this symptom
• 40% of people with bipolar Lehrer, D. S., & Lorenz, J. (2014). Anosognosia in Schizophrenia: Hidden in Plain Sight. Innovations in Clinical Neuroscience, 11(5-6), 10–17.
Anosognosia and Justice Involved People • 15-25% of inmates in jail report symptoms associated with
severe mental illness.
• 9% report schizophrenia 18% bipolar
• Anosognosia is directly associated with heightened risk for violent behavior, arrested, victimization and suicidal behavior.
Insight and Adherence
“We never “win” on the strength of our argument,
we win on the strength of our relationship.”
Xavier Amador
Expectations of people with Anosognosia
• Gratitude• Receptiveness • Adherence
Do NOT Expect
• Frustration, Anger, Hostility, Fear and Suspicion
• Loneliness and demoralization• Overt and secretive “non-
compliance”
Do Expect
Listen (Reflectively)
Listening without judgement, commenting, disagreeing, or arguingListen for:
• Beliefs about having a mental illness• Experience and attitudes around taking medication• Concept of what she can and cannot do• Hopes and expectations of the future
Empathize
Frustrations
Fears
Discomfort
Desires
Delay Giving Your Opinion
• I promise I’ll tell you whether I think you are sick. But first, if its ok with you, I would like to hear more about (whatever you were talking about before). Would that be ok with you?
• I promise to answer your question about whether you should stop taking medication. Before I do, I want you to know that I think your opinion about this is far more important than mine. So can you tell me all the reasons why you want to do that?
The Three A’s• Apologize
• Acknowledge Fallibility
• Agree to disagree
Agree
• Discuss only perceived problems/ symptoms
• Review advantages and perceived disadvantages to treatment
• Reflect back and highlight perceived benefits of treatment
• Agree to disagree
Partner
• Working together to achieve mutual goals
• Discuss options the client did not consider
Case Study: Conventional Interview
The LEAP Model in Practice
What Is A Crisis?
What Is A Crisis?• When our stress level outpaces our real or perceived resources,
a crisis can occur.
TACT TIME
ATMOSPHERE
COMMUNICATION
TONE
TACTTime Have a plan Use patience Get as much information beforehand
TACTAtmosphereDistance (Do you have it? Use it.)Be aware of stimuli that can increase tension (What kind of stimuli can increase tension?)
Engage/Build Rapport (How? And Why?)Give your nameGet their name
Listen and look for cues to build rapport (What can you hear or see that you could use to build rapport?)
TACTCommunication/Tone• Demonstrate compassion• Ask questions• Be direct• Restate what you hear and acknowledge• Repeat/reassure• Be aware of non-verbal communication and positioning• Self check constantly – maintain composure of own emotions
Additional Tips• Keep your directions simple• Respond to feelings, not just words• Focus on one thing at a time• Thank the person for following directives, no matter how small• Get to know what types of people and/or situations lead you to
feel afraid, annoyed, etc.
Questions?
Adult Protective Services Technical Assistance Resource Center 32
