Communicating for Persons Centered, Relationship Oriented Counseling

Purpose: Support consumers and families to consider fully their situation and the possible options for addressing their concerns, strengths, needs, and preferences by * emphasizing relationship-building, * counseling, and decision support * offering long-term care choices * considering long-term care futures planning Person Centered Planning * Self-determination * Community relationships * Circle of support * Exploring and making decisions * Taking action Goals: Assisting individuals make choices for long term care by * Providing information, education and self awareness * Facilitating access to services * Providing decision support * Creating a plan Relationship Oriented Care * Valuing and respecting person * Shared understanding of person’s experience, life vision and goals * Self reflection * Attentiveness to experience * Relationship with community

Following is a summary of basic communication and listening skills important when working with some one seeking Long Term Support Counseling. Also included is a general guide for the type of communication skills that might be most useful at different stages of a call or visit. This is a ‘ for your information’ in hopes that it will be helpful for you and those you serve.

Questioning Technique DescriptionPurposeExamples Closed Questions Intended to be answered with a yes, no or single word/phrase. Closed questions have the following characteristics: * They give you facts. * They are easy/quick to answer. * They keep control of the conversation with the questioner.  As opening questions in a conversation, it makes it easy for the other person to answer, and doesn't force them to reveal too much about themselves.  For testing understanding. This is also a great way to break into a long ramble.  For achieving closure of a persuasion (seeking yes to the big question). *It's great weather, isn't it? *Are you alone today? *Where do you live? *Do you want to move into your own apartment? *Are you satisfied with your current living situation? *Would you prefer a different living arrangement?

Questioning Technique Open Questions Description Intended to elicit a long answer that asks the respondent to: * think and reflect. * give opinions and feelings. * give control of the conversation to the person. Questions usually begin with what, how. "Tell me" and "describe" can also be used in the same way as open questions. Asking questions beginning with ‘why’ can be problematic as these questions can often be perceived as challenging the person and are best avoided. Purpose  As a follow-on from closed questions, to develop a conversation and open up someone who is rather quiet.  To find out more about a person, their wants, needs, problems, and so on.  To get people to realize the extent of their problems.  To help them feel positive about talking with you. Examples *How are you managing at home? * What concerns you most about living alone? * What is most important for you as you think about the future? * How can I help you to talk with your daughter about not living with her?

Questioning Technique Funnel Questions Description Involves starting with general questions, and then honing in on a point in each answer, and asking more and more detail at each level. Easier if you start with a closed question followed by more open questions. Purpose Finding out more detail about a specific point: "Tell me more about Option 2." Gaining the interest or increasing the confidence of the person you're speaking with. Examples Tell me more about Option 2. *Have you used VNA home care services before? Did they solve your problem?, What made this option work (or not work) in helping Leading Questions A specific type of close ended question phrased in a manner that tends to suggest the desired. Leading questions are generally undesirable as they can result in false or slanted information. Subtly prompts the respondent to answer in a particular way, usually the interviewers way. *Do you fight with your daughter much of the time? *Isn’t the nurse giving you the care you need?

Goals of the Long Term Support Counseling Interview  Most interviews seek to achieve one or more of the following goals: 1. Obtain information about the person 2. Obtain the person’s opinion, feelings, concerns, questions 3. Determine what the person wants to know and how much the person already knows about the issue/concern 4. Explore/assist consumer to develop an action plan  For Long Term Support Counselors, the client interview will follow a general outline. The outline as noted in the attached overview will need to be modified based on the person(s) attending the interview, the purpose and the specific context but many of the elements will remain the same. Sample questions often used at the different stages of the interview are noted in the 3 rd column.

Visit ElementAspects of elementGeneral Communication Style Meeting the clientIntroducing selfClose ended How to address client Brief description of your role Describe that you will be making brief notes during the meeting to ensure correct information Assess hearing/speech Collect demographic data per agency protocol Use form to collect data or Use general discussion/sharing Close ended Open ended Determine client’s purposeRequest client’s description or explanation of why here Open ended Questioning Assess immediacy of problemIs this an emergency, urgent, evolving, chronic, future oriented situation? Close ended Explore as needed to determine client’s vision, goals, preferences, values, knowledge and understanding Obtain additional information, and assessment data to ensure your understanding of purpose, goals, need, background, context Open ended Questioning Paraphrasing Empathy This is an overview of a typical Long Term Support Counseling call/visit. It presents category of visit elements, overview of interactions associated with each element, and general communication typically applied to the type of element.

Visit ElementAspects of ElementGeneral Communication Style Summarize your knowledge/understanding; continue interviewing until client affirms your understanding Background to problem; Level of client’s knowledge/feelings about situation, options, decisions; Client’s expectations/goals re: information, assistance, future, plans, decision support Summarizing Paraphrasing Close ended Open ended Develop action planNeed for additional client assessment such as Home visit, meet with other persons; Client need for information; Decisions needed/made; Actions needed Follow up visits/calls Open ended Summarizing Determine Next steps based on action plan By you; by client; by othersSummarizing Open ended Close ended

Visit Element Review visit. Give client copy of written plan; ensure client validation Aspects of Element Statement of problem Decisions Action plan Next steps Follow up plan General Communication Style Close ended Open ended Post interview write up (SAMS)Per agency protocol Materials adapted from: New Hampshire Long-Term Care Support Counseling: Person Centered Communication Training Workshop II, Communicating for Person Centered Relationship Oriented Care (PCROC) focuses on communication skills that promote and support the long term care counseling process. PCROC combines the person centered planning processes that have been an initiative for working with people with disabilities with the relationship centered care model advocated by the health care community. Source: New Hampshire