Conflict Resolution& De-Escalation

Katie Robbins Case, MSW, LISW

Background:

➔ Medical Social Work(Home Health, Hospice, Inpatient, Outpatient)

➔ Crisis Intervention (ASAP program through Heartland Family Service)

➔ Outpatient Mental Health Therapist

…………………………………………………………………………

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!

Example:

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

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

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

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

Example:

Helpful

➔ Listening ➔ Patience➔ Explaining ➔ Validating

Not Helpful

➔ Staff putting MD’s down➔ Not following through➔ Defensive➔ Belittling

All better!

And no more motorcycles :)

How do your experiences influence your work with clients/patients?

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

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?

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

Dysfunctional Conflict Management Styles

➔Emotional Control = Situational Control◆ Think more clearly◆ Listen better◆ Observe body language◆ Unbiased/neutral◆ Offer empathy and patience

Crisis/Conflict Intervention & Mediation

Partner with PoliceWorking in the Community

Individuals in Mental Health CrisisYouth/ families having severe, negative behaviors

Example

➔ Ran away from home➔ Police brought her back➔ Lots of yelling, slamming doors

➔ 17 year old female➔ Fighting with parents➔ “Spoiled brat”

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

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

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.

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

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

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!

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”

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?!

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…

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.

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

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?’)

Questions?

Comments?