1. What your clinical staff won't tell you - But you need to know! Presented by: Ginger R. Bandeen, LCSW, CHC

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

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

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.

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

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

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.

8. With this in mind, it’s 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 person’s clients, other clients, and the community – Some factors are beyond our control.

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

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

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.

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 you’ll hear.

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 organization’s mission.

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.

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

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

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

18. Practice Reflective Listening  Don’t 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.

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.

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

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 organization’s values & mission

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.

23. Analyze Systems – Family Systems ‘Family of origin’ roles Team roles outlive individuals Interdependence – Person-in-Environment Multiple systems interact Observe group dynamics

24. Practicing Mindfulness Consider environmental factors – Location, management, and décor 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.

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.

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.

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

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 person’s humanity.

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