life is filled with human interactions:

Life is filled with human interactions:

Engaging and partnering with clients, co-workers and

communities

Lois Seefeldt, RN, PhD

2014 Wisconsin Infant and Early Childhood Mental Health Conference

Elkhart Lake, WI

PRESENTATION OBJECTIVES1. Describe engagement and partnering as optimal client, agency and peer interaction components.

2. Identify how communication encourages or discourages engagement and/or partnering.

3. Identify and demonstrate at least two techniques for engaging others in optimal encounters.

4. Identify one outcome of positive communication related to engagement and partnering.

SEEFELDT JUNE 17, 2014 WISCONSIN INFANT AND EARLY CHILDHOOD MENTAL HEALTH CONFERENCE 2

FROM W

HERE DO W

E GET

OUR IDEAS O

F

ENGAGEMENT AND

PART

NERING?


DEVELOPMENT OF RELATIONSHIPS

Bowlby (1980) first proposed the idea of how we develop our ideas of interactions with others• First attachments• Ongoing relationship experiences• How we respond to others• How others respond to us• Real and perceived expectations are formed about future interactions

• A mental blueprint (map) is developed and becomes our INTERNAL WORKING MODEL for future interactions


ENGAGEMENT

AND

PART

NERING


WHAT DOES EVERYONE WANT?

CLIENTS?? COWORKERS?? COMMUNITIES??


WHAT IS AT THE HEART OF MOST CONFLICTS?

ENGAGEMENT AND PARTNERING•How would clients define…….•How would co-workers define…..•How would teachers, social workers,

nurses, therapists define…..•How would community agencies define…….•How do you define……..


PARTNERING

What words mean Partnering?


PARTNERING

Associating Affiliating

Uniting Connecting

Accompanying EscortingTeaming-up Linking-

in


SEEFELDT JUNE 17, 2014 WISCONSIN INFANT AND EARLY CHILDHOOD MENTAL HEALTH CONFERENCE

10

Partnering

ENGAGING

What words mean Engaging?


ENGAGING

Involving OccupyingEngrossing AbsorbingParticipating ConnectingInterlocking MeshingAttracting Holding



Engagement

ENGAGEMENT AND PARTNERING

• In her 2008 article “Strategies for engaging adolescent girls at an emergency shelter in a therapeutic relationship: recommendations from the girls themselves” Karin Eyrich-Garg identified the work of Coatsworth et al, 2001 and Robbins, et al, 2003, that “engaging clients is the first step in forming a working relationship…. if clients are not engaged, they will likely not return for another session, attend but not participate in treatment, or attend and participate minimally in treatment.” (p. 376)


ENGAGEMENT AND PARTNERING

• In her 2008 article “Strategies for engaging adolescent girls at an emergency shelter in a therapeutic relationship: recommendations from the girls themselves” Karin Eyrich-Garg identified the work of Coatsworth et al, 2001 and Robbins, et al, 2003, that “engaging clients is the first step in forming a working relationship…. if clients are not engaged, they will likely not return for another session, attend but not participate in treatment, or attend and participate minimally in treatment.” (p. 376).

COLLABORATIVE RELATIONSHIP


WHAT DO WE WANT FROM ENCOUNTERS?

•What do clients want?•What do you want when interacting with clients?•What do you want when interacting with community agencies?•What is similar and overlaps?•What is different?


HOW DO YOU KNOW WHEN YOU HAVE A SATISFYING INTERACTION

• Think about the most satisfying interaction you have had with:

•A client•An agency•A co-worker•A community group

• What made it satisfying?• Did the other person feel that

satisfaction?


•Look like?

•Sound like?

•Feel like?

•End like?

WHAT DO NON-ENGAGED, NON-PARTNERED

INTERACTIONS……..


What are the outcomes?

•Client home•Community

agency•Your office•The daycare setting•The classroom

•How does this affect outcomes and end results?

WHEN NON-ENGAGEMENT AND NON-PARTNERING WHAT OCCURS

IN THE…



“Wait they’re going In opposite directions!!

Did they hear me?”

WHEN PARTNERING AND ENGAGEMENT DO NOT

OCCURWhat gets in the way of

partnering and engagement for the:Client

Agencies You


Basic needs

Maslow’s Hierarchy of Needs

Safety and security

Comfort and belonging

Self esteem

Self actualization


CHALLENGES

THE D

IFFIC

ULT O

R DEMANDIN

G PERSON


CONNECTING WITH A DIFFICULT PERSON

• What gets in the way?• Leads to “poor helping

relationships”(de Boer & Coady, 2007)

• Clients perceived disrespected, judged, demeaned, not being heard or understood ”(de Boer & Coady, 2007)


CONNECTING WITH A DIFFICULT PERSON

• Engaging co-workers and staff requires the same principles as with clients and community members

• Muha & Manion (2010) identified that there needs to be “positive psychology..” in the workplace (p.50).


CHALLENGES

WHEN S

OMEONE’S C

ULTURE IS

DIFF

ERENT

FROM O

UR OW

N


ENGAGING OTHERS OF CULTURES DIFFERENT THAN OUR OWN

• Often feel powerless to express their needs to the professional especially if basic needs have not been attended

• Often as a result feel has not been

“heard”Caple, Salcido, & di Cecco (1995)


4 PRINCIPLES OF “PERSPECTIVE BUILDING” IN RELATION TO CLIENTS, CO-WORKERS AND

COMMUNITY MEMBERS OF DIFFERING CULTURES FROM OUR OWN

• No single American culture• Diversity within each culture• Acculturation is dynamic and individual• Diversity needs to be acknowledged and valued• We must be inclusive in our interactions


PRINCIPLES OF “PERSPECTIVE BUILDING” IN DIFFERING CULTURES

Use of basic etiquette Listen Cultural check-in with client Identify cultural imperatives---expectations, rituals and

taboos Use interpreters Words and body communication-----Be aware


CHALLENGES

WHAT

IF T

HE DIFF

ICULT

PER

SON IS A

CO-W

ORKER O

R YOUR B

OSS?


REFLECTING THE MISSION AND VALUES OF YOUR ORGANIZATION

•Living the mission and vision of your organization•Engagement and Partnering as core values of your organization•How do you demonstrate the mission and

values in your daily interactions?•Is there a “lived” integrity in your daily mission and work?


POSITIVE INTERACTIONS WITH STAFF/COWORKERS/OTHERS

• 6 Principles of Positive Psychology (Muha & Manion, 2010)

• Passion—wanting to achieve the most optimal functioning—this is most often intrinsic—so needs to be tapped into

• Relationships—work well only when there are more than 5 positive encounters for every 1 negative encounter

• Optimists—look for mutual satisfaction within solutions to problems—appreciate the positives

• Proactive—consistently using ones strengths to achieve the best outcome—looks at the big picture

• Energy—routinely recharges to maintain an optimal level of functioning—replenish—help others to replenish

• Legacy—knowing your purpose allows you to use your passion for optimal functioning and moving toward the overall outcome


ENGAGEMENT

AND

PART

NERING


Viewing each encounter as an opportunity for a sacred interaction of partnering

HEALING AND SACREDNESS

Healing, sacred encounters what do they have to do

with this work?


QUALITY CARE AND INTERACTIONS (JAYNE FELGEN, 2004)

• “Quality care is deeply respectful of the dignity of each person, is attentive to mind, body, and spirit, and promotes the healing power of relationships

• A caring and healing environment creates the context for relationship-based, [client]-centered [interactions].


RELATI

ONSHIP-BASED

INTE

RACTIONS

PURPO

SEFUL C

ONNECTIONS W

ITH O

THERS


Remember the old Midas commercial…“Pay me now or pay me later”

COMMUNICATION


ENCOURAGING ENGAGEMENT AND PARTNERING

INEFFECTIVE COMMUNICATION• May contribute to:

• Failed communications• Errors• Missed information• Missed transfer of information• Lack of an attention to detail• Missed procedural “follow-through”• Misunderstandings of oral or written

communication


HOW WE COMMUNICATE AND HOW IT IS INTERPRETED

•Verbal•Non-verbal•Written•E-mails


DEMONSTRAT

ING C

ARE

THE R

OOT OF

ENGAGEMENT AND PA

RTNERIN

G


ACCORDING TO KRISTIN SWANSON“When we are being

emotionally present for our [clients], they sense that no matter how bad the circumstances might be, we won’t abandon them”

Swanson, K. (2004) Infrastructure: Embedding professional nursing practice in relationship-based care. In M. Koloroutis (Ed.), Relationship-based care (p. 324). Minneapolis, MN: Creative Health Care Management. .


LISTENING

What words mean Listening?


LISTENING

Attending Heeding

Paying-attention Taking-note


LISTENING• ” Connection between “listening,

improved interpersonal communication, professional growth, and job satisfaction” (Madelyn Burley Allen, p. 2)

• “If you are a skilled listener, more people will respond to you in a positive way” (Madelyn Burley Allen, p. 2)

• “On average people are only about 25 percent effective as listeners.” (Madelyn Burley Allen, p. 3)


2 ears and 1 mouth---gives us a clue

KRISTIN SWANSON’S THEORY OF CARING 1993

• Maintaining a Belief• Knowing• Being with• Doing For• Enabling


What does genuine caring “feel like” ?

5 CARING PROCESSESKRISTEN SWANSON 1991 p. 355


STRUCTURE OF CARINGKRISTEN SWANSON 1993


WHAT DOES….• What does it feel when

someone really listens to you?

• What does it feel like to really listen to someone else?

(Madelyn Burley Allen, p. 3)


LEVELS OF LISTENING ( MADELYN BURLEY ALLEN, P. 14)

• Level 1 Empathetic Listening• No judgments• In other’s shoes• Hearing their “story”• Swanson’s—”Being with”

• Level 2 Hearing the words but not really listening

• Surface communication with no “deep meaning understanding• Listen logically• Content-not feeling-emotionally detached

• Level 3 Listening in Spurts• Tune in and tune out• Thinking about what is next on own agenda


NON-VERBAL COMMUNICATION AND LISTENING

• Behaviors that encourage the other to speak

• Behaviors that dissuade the other from speaking

• Our posture, how we sit and/or stand

• Positive body movements

• Facial expressions

• Arm and hand gestures

• How do you encourage feedback and discussion?


WHAT WORDS DO WE USE?

HURTFUL WORDS

•Birth Parent

•Adoptive parent

•Choose

•Give up for adoption

•Special needs children

•Rescuing orphans

•HIV positive child

•Challenging children

MINDFUL WORDS

•Expectant parent

•Prospective Adoptive Parent

•Consider

•Placement (relinquish)

•Special needs placement or Children with special needs

•Providing homes for children

•Child who is HIV positive

•Children with challenging behaviors


MOTIVA

TIONAL

INTE

RVIEW

ING

• Become an advocate

• Guide clients

• Client development of self-defined goals

Overr

idin

g goa

ls


TECHNIQUES TO ENCOURAGE PARTNERSHIP- BASED

COMMUNICATION

• Listening• Mindfulness• Attunement• Relationship-based interactions• Remember the spotlight• Reflective Practice• Guided Participation


RELATIONSHIP

What words mean relationship?


RELATIONSHIP

Association Connection Affiliation Rapport

Bond Liaison Link Correlation Tie


MOTIVATIONAL INTERVIEWING

• “Patient-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.” (Miller & Rollnick, 2002, p. 25)

• “Promotes change and create an interpersonal connection to make suggested changes a reality” (Marquardt & Vezeau, 2008, p 22)

• Meta-analysis of 119 studies assists with other methods dependent on the delivery by the worker (Lundahl, Brownell, Tollefson, & Burke, 2010


PRINCIPLES OF MOTIVATIONAL INTERVIEWING

(MARQUARDT & VEZEAU, 2008; LUNDAHL, BROWNELL, TOLLEFSON, & BURKE, 2010)

• Expressing empathyTrust relationship

• Developing discrepancy• Between current and desired behaviors

• Rolling with resistance• Calm supportive tolerance—avoid conflict

• Supporting self efficacy• Clients are their own experts—collaborative

development of realistic plans


REFLECTI

ON

IMPR

OVING T

HE INTE

RNAL WORKIN

G MODELS


REFLECTION

• Evidence supports the practice of reflection to enhance professional self understanding and clarity of direction

• Reflective in personal professional practice asks us to “stop” and think about our place in the world of our clients and ourself


VALUE OF REFLECTION IN PRACTICE• Come to terms with what we want

to do and what we do• Through reflection we see the

client as “the central focus”• Reflection may be done in

private---through journaling---or with another person or in a group


SOCIAL WORKER BEHAVIOR AND CLIENT RESPONSE

• 2008 UK study of social workers mothers where child welfare issues existed,

• presence or lack of worker display of empathy was the significant link between worker behavior and client resistance or lack of resistance

• Use of reflection in the relationship was significant

(Forrester, Kershaw, Moss, & Hughes, 2008)


ATTUNEMENT WITH YOUR CLIENTS (CACCIATORE & FLINT, 2012, P. 65)

• Emphasis on • mindfulness, • responsiveness, • empathy, • self awareness

• Embrace contemplative practices• Intentional behaviors• Deep awareness of own emotional state• Daily mindful thought-prayer or meditation• Stress reduction• Altruism


MINDFULNESS“The desperate state of our world calls us to action. Each

of us has a responsibility to try to help at a deeper level of our common humanity….”(p. 8)

“Cultivating an attitude of compassion and wisdom are slow processes….”(p. 21)

“As you transform your minds, you will transform your surroundings. Others will see the benefits of your practice of tolerance and love, and will work at bringing these practices into their own lives.” (p. 21)

The practice of mindfulness is how this state of understanding is achieved.

Dalai Lama (2002) , How to practice: The way to a mindful Life. New York: Simon & Schuster Pocket Books


MINDFULNESS (CACCIATORE & FLINT, 2012)

• Be in tune with yourself

• Before meeting with the next client• Close your eyes• Feel your breathing• Before opening the door or bringing the next client back to your desk imagine that person

• Think of their ‘suffering’• Approach with intention-be mindful and compassionate


GUIDED PARTICIPATION

• Structure to guide development of expectations regarding the interaction (Schroeder & Pridham, 2006)

• From sociocultural theory (Dewey, 1938)

• Thinking and learning through mentorship (Rogoff, 1993, 1990; Klass,1996)

• A collaborative process (Klass, 1996)

• Guidance from the expert to the novice (Rogoff, 1993, 1990; Klass,1996)

• Aimed at the anticipation and prevention of difficulties (Rogoff,1993; Mastergeorge, 2001)


Problem solving and Competency development

SEEFELDT JUNE 17, 2014 WISCONSIN INFANT AND EARLY CHILDHOOD MENTAL HEALTH CONFERENCE 66Used with permission Bereavement Services 9/2012

ADVANCED T

ECHNIQUE

TO IM

PROVE

ENGAGEMENT AND

PART

NERING W

ITH

PATI

ENTS/C

LIENTS

VIDEOTA

PED F

EEDBACK


USING VIDEO-TAPING FOR FEEDBACK

• Has been used for research (Beebe & Stern, 1977; Beebe et al., 1985; Tronick et al., 1978; Seefeldt unpublished dissertation 1997, Ray & Tickle-Degnen, 2004; Lim et al., 2005; Stein, 2007; Beebe et al. 2008; Lawrence et al., 2012)

• Interactions are very complex, • the use of video-feedback allows all participants

and observers to see the interaction together

• Allows for discussion

• Assists with cue identification and response discussion


GUIDED VIDEO-FEEDBACK

• Enhances interaction development• Cognitive• Social• Emotional

Martin, 2007


ADVANTAGES OF VIDEOTAPING AND FEEDBACK

• According to Cohen & Beebe (2002) • Video replay may be: *viewed in normal or slowed speed *stopped to allow for contemplation and discussion

• Parent and professional see the same interaction

• Without a video the interaction discussion relies on memory


IF THESE TECHNIQUES WERE CONSISTENTLY IMPLEMENTED WHAT

WOULD ENCOUNTERS

FEEL LIKE?

RESULT IN?


WHAT WOULD BE DIFFERENT?

• How would I know there is engagement between staff and client?

• How would you know the client is engaged?

• How would the client know that you are engaged?


IMAGIN

E WHAT

COULD

BE:

Engaging andpartnering for a sacred

encounterTh

e cl

ient-

wor

ker r

elat

ionsh

ip


ENGAGING AND PARTNERING

“Holding in your mind that nothing within the [interaction] is routine [for your client] will help prevent you from allowing it to become routine for you”

Manthey, M. Vision: beginning at the beginning. In M. Koloroutis (Ed.), Relationship-based care (p. 324). Minneapolis, MN: Creative Health Care Management.



Questions?


Thank you

Lois Seefeldt, RN, PhDHealthcare Education and Consulting

[email protected]

life is filled with human interactions:

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