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What your clinical staff won't tell you - But you need to know! Presented by: Ginger R. Bandeen, LCSW, CHC Slide 2 Session Overview I. Communication challenges A. What makes communication difficult? B. What makes communication essential? II. Communication skills and techniques A. Formal tools B. Cultivating a reputation C. Clinical skills to borrow Slide 3 Communication Challenges Style distinct methods of communicating Goals the purpose of the conversation Language word choice, jargon Content what are people willing to share? Emotions fear, anger, pride Social setting stigma, groupthink Culture values, diversity Other cognitive dissonance, defenses Primary DifferencesUnderlying Dynamics Slide 4 Beneath the surface of interactions: Clinical staff may have huge, fragile egos. Staff see themselves as experts. Staff often experience feelings of incompetence. Defense mechanisms help staff survive in a climate of certain uncertainty. Slide 5 Underlying Dynamics What people may not tell you In many clinical decisions, the jury is still out. Treatment decisions are not right and wrong Options are limited by the system Choices can feel like the lesser of two evils Slide 6 Underlying Dynamics Many clinical staff feel isolated, asking themselves: How can we balance conflicting professional responsibilities? to our clients/patients to our values to our employer to our profession to our community Slide 7 Underlying Dynamics From the perspective of many clinical staff: The tail (compliance) is wagging the dog (services). Staff and clients develop skills in maneuvering through systems and bending the rules. These skills are sometimes then used in our own systems. Slide 8 With this in mind, its no wonder! Clinical staff are often hesitant to come forward. Staff evaluate the potential risks & benefits: Personal factors: the staff person, family, friends Organizational factors: the agency, the staff persons clients, other clients, and the community Some factors are beyond our control. Slide 9 Compliance and Communication How does quality communication impact the elements of Compliance and Ethics Programs? 1) Standards and Procedures 2) Oversight 3) Education and Training 4) Auditing and Monitoring 5) Reporting 6) Enforcement and Discipline 7) Response and Prevention 8) Commitment to Ethics 9) Evaluating Effectiveness Slide 10 How can we tip the scales in favor of open communication? Organizational factors Non-retaliation policy/practices Open and supportive culture Compliance, ethics, and the mission Interpersonal factors Relationships Reputation Slide 11 Organizational Culture All organizational culture is local. Direct supervisors define organizational culture. One unethical or demoralizing supervisor can cancel out positive messages everywhere else. Retaliation can take many forms. Slide 12 Formal Feedback Tools What are some methods for gathering feedback if all else fails? Online Surveys Example: Compliance and Ethics Survey Give information Use multiple-choice &open-ended questions. Focus Groups Use clear parameters Be prepared for what youll hear. Slide 13 Cultivating Your Reputation Build credibility by being someone who: Is willing to seek out knowledge Learn about dilemmas faced by clinical staff. Acknowledge gaps in understanding. Avoid assumptions. Has shared values Demonstrate commitment to the organization. Connect ethics and compliance to the organizations mission. Slide 14 Cultivating Your Reputation Build trust by being someone who: Models transparency Acknowledge flaws in the program, and yourself. Recognize when your values conflict with your role. Offers mutual respect Give people the tools to do their job, and the benefit of the doubt. Slide 15 Interpersonal Factors Compliance Officers can improve relationships by borrowing the tools and communication techniques used by clinical staff to encourage open, authentic conversations. Clinical skills can enhance communication at all levels: One-on-one interviews Group meetings and trainings Presentations Investigations Disciplinary meetings Slide 16 Compliance vs. Counseling Purposeful Mindful Built on mutual respect Expectations of confidentiality Ethical responsibilities to be non-directive Expectations of objectivity Scope of the conversation The client is not just the individual, but also the agency as a whole SimilaritiesDifferences Slide 17 Clinical skills you can borrow Clinical skills Compliance Officers can use to increase the effectiveness of communication: Reflective listening Observing the here-and-now Respecting boundaries Selective self-disclosure Thinking about systems Mindfulness Building human connections Slide 18 Practice Reflective Listening Dont reflect words back verbatim! Use nonverbal and contextual clues to understand the meaning behind statements. Offer interpretations carefully. Check to clarify Avoid emotionally-charged words Practice mirroring Observe and mimic style, word choice, etc. Slide 19 Use the Here-and-Now Consider pointing out: Posture, behavior, expression Long silences Half-answers Unspoken statements Word choice Connect observations to content. Values, intentions, and fears Use caution and tread lightly. Offer the opportunity, but never force the issue. Slide 20 What could be unspoken? People lead complicated lives. Clinical staff are affected by: Personal goals Unresolved family issues Financial stressors Work can provide people with: A salary that supports our life A sense of purpose An escape/rest from home Positive reinforcement Slide 21 Respect Boundaries Begin by explaining: Your role, goals, and the process Limitations of confidentiality/anonymity Other constraints (time, etc.) Meta-communication = talk about talking Discuss the pros and cons of being open Find a connection to the organizations values & mission Slide 22 Selective Self-Disclosure Use generalizations to describe common feelings/barriers: A lot of people feel Some people I talk to say Cautions watch out for these pitfalls: Diverting the conversation to you Leading the person to feel un-heard. Slide 23 Analyze Systems Family Systems Family of origin roles Team roles outlive individuals Interdependence Person-in-Environment Multiple systems interact Observe group dynamics Slide 24 Practicing Mindfulness Consider environmental factors Location, management, and dcor in your office. Counselors carefully consider furniture arrangement, sound- proofing, etc. Consider tools to reduce interruptions (sign on the door, do- not-disturb on your phone) and make expectations known Minimize power differences and maximize comfort. Slide 25 Practicing Mindfulness Prepare for one-on-one and group meetings Set aside time to process and re-group, rather than moving from one person to the next. Connect to your personal values and mission. Slide 26 Practicing Mindfulness During your meeting Balance attention to: Being in the moment The purpose and long-term goal Content and process. Take on a stance of not-knowing Be authentically curious. Slide 27 Practicing Mindfulness End your meeting with a wrap-up Give the person time to re-collect themselves Use chit-chat to transition back Verify that everyone leaves with clear expectations Slide 28 The most important factor Seek out the spark of humanity in relationships Find connections that will help you see through barriers. Identify common values, ideals, or our shared humanity. Speak and act with unconditional positive regard Approach difficult situations with respect for each persons humanity. Slide 29 Questions/Comments For more information, please feel free to contact: Ginger R. Bandeen, LCSW, CHC Quality Improvement Manager/Compliance Officer Columbia Community Mental Health P. O. Box 1234, St. Helens, OR 97051 (503) 397-5211, x254 gingerb@ccmh1.com