So, everybody click okay. So, let me just say this, folks, I want to thank Katie and Jamie for the opportunity to be here with all of you today to engage in this conversation. Part one, there's a part two as well. We'll spend 90 minutes together today and then we'll finish up part two in the next 90 minute installment. But I want to thank you for the opportunity to be here because I must say, honestly, and from a very selfish perspective, engaging in this particular conversation, I agree with what Jamie said, and I will go so far as to say that anybody who is having conversations with other people in a social service setting can benefit from being in a learning community focusing on this particular topic. Because as Jamie also alluded to, we don't always have a clear start point of when we know we're going to be called on to deescalate. But as things come up, and we want to be able to have these particular skills, and this particular way of being, that can hopefully contribute to making sure that everybody stays safe, that the individual who may be escalated or escalating can sort of come back down to be able to engage, hopefully in a conversation, and hopefully receive services. Now, before I share the first slide, I do have to acknowledge, and I think it's important to acknowledge this, that sometimes everything that we may try may not work to deescalate a particular situation. And I want to be very clear about that, folks. That doesn't mean you've necessarily done something wrong. It just means that that particular situation, because of what was going on in that particular situation, it was not necessarily responsive, and we maybe needed to call in additional help. Or, and I'm very curious, and you can do this by a show of hands, and if I can't see your hands, you can type it in the chat. But I'm wondering, is there anybody in our learning community who's ever had to ask for assistance from 911? Have you ever had to call 911 in a situation? Okay, so I'm seeing a couple of people nod hand. Yeah, okay. So, okay, Irene as well. So, I would venture to guess, and I don't want to make an assumption, that whenever anybody has been in that situation, you've probably had very mixed feelings about making that outreach and that determination, because you know what it means. And it doesn't necessarily feel, quote unquote, like a success. And again, the thing I'd like you to really consider is when you need additional support, get the additional support you need, because your safety and the safety of that other person and the safety of your colleagues or the other patients or clients is what is the priority. That everybody stays safe. And taking that action, you probably have done it in order to keep everybody safe. And it still may not have felt very good. And that's why one of the things that hopefully we're going to talk about is what I frame for this conversation, a process of de-escalation. So, we're thinking about de-escalation as a process, as opposed to simply an event that we respond to, resolve, and then go forward. Okay, so that we're thinking of de-escalation as a process. I'm not going to say anything more about that right now. But I am going to show you the first slide. Actually, before I show the first slide, let me just say briefly by way of introduction. I'm currently, I have the great opportunity to work with Katie and her team from the ORN. And I am currently a senior staff trainer and curriculum writer for the Northeast and Caribbean Addiction Technology Transfer Center. And that does mean that I am at times forced to go to Puerto Rico, St. Thomas, and St. Croix to deliver training. But today I have not been forced to do that. I am here with you, and I'm glad of that. I'm also a research project director at the New York State Psychiatric Institute. And I'm also a member of the Motivational Interviewing Network of Trainers, the international organization training people to use the evidence-based practice of motivational interviewing. I'm a social worker by training and a graduate of Hunter College School of Social Work in New York City, with an emphasis particularly on group development and group facilitation. So, again, I want to thank you so much for the opportunity to be here. I began my social service career in 1991, providing direct services to people living with HIV and AIDS. And I did that work, direct service work, for a little over 12 years when I made the transition into training, technical assistance, and workforce development. So, I'm going to share my screen with you, share the first slide. And I do need to give a caveat about the title of this particular learning community course, which will make sense based on what we've discussed before. And you can just confirm for me using the chat by typing the letter Y that you can see the slide and you can see me. I can't see you. But if you can see the slide and you can see me, just type the letter Y in the chat. And I'm also fairly sure that you are able to see it full screen. Excellent. Very good. So, the title, the official title for this course is De-escalation Basic Tools for Social Workers. Now, the reason I put it in smaller type like that is because when we originally had this course approved for credit, we originally developed it specifically for social workers. And it was developed, I think, maybe five or six years ago now. And it's been, of course, updated. We found that there was a lot of requests for this particular topic. And anybody who is engaging in conversations with other folks in the social service setting, regardless of whether they were a social worker or whether they were the front desk staff or whether they were monitoring the doors, whatever their security team, anybody who is having those conversations and those interactions, we found actually took something away from this particular learning community conversation. So, we kept the title the same so that you can get the credit hours. But we de-emphasized the font size because we want to make sure that everyone who's in the learning community, and there are 48 of us in the learning community today, that everyone in the learning community can benefit from this particular learning community conversation. Having said that, as Katie mentioned, this particular conversation is brought to you by the Opioid Response Network. I am brought to you by the Opioid Response Network. And the Opioid Response Network is committed to this being a learning community conversation that is actually relevant to your work and actually supports what you do. Because of that, because this hopefully will be an actual conversation, what we talk about may not necessarily reflect the official views or positions of the funder, and that's okay. Because this is actually meant to benefit you and to support you, in addition to give you three hours of credit if you need that for your credentialing. But it's actually intended to be useful and relevant to what you're doing. These are some of the other things related to the Opioid Response Network. And as Katie said, if you have additional needs, if you have additional requests, please do follow through with Katie, and hopefully those can be addressed coming down the road as well. And this is some specific contact information for the ORN. All right. So, as we hopefully engage in this learning community conversation, the 48 of us who are here... Oh, and Katie, thank you so much. Katie also put her direct email in the chat again as well. I think you put it in before too. So thank you for that. So, as the 48 of us hopefully engage in this two-part learning community conversation, primarily one of the major guidelines that I would ask us all to be considerate and aware of is that how we talk to each other, the words we use, the language, the tone we adopt, actually matters. And we want to be using language and tone that is respectful, inclusive, and welcoming for all 49 of us who are now in the learning community. So, overarchingly, please let this Words Have Power guide our conversation, in addition to a few other basic guidelines. There will be a brief evaluation at the conclusion of Part 2. We would very much appreciate your feedback, so we would ask you to complete that at the end of Part 2. PowerPoint makes it absolutely official. Welcome! Bullet number one. Also, because we're a learning community of 49 people now, we may hear things, express things that other people in the learning community don't believe, don't agree with, don't have the same values. What I would ask is during our less than 90 minutes together that we offer each other the respect of listening, even if we don't necessarily agree with what somebody else is saying, and that you are open to the idea of staying engaged in the learning community conversation. And then the last guideline that I would ask is that everybody could please speak from the I. Now, I'm going to advance the slide to the goals, but before we look at this a minute, I'm just going to ask, can everybody agree to those learning community guidelines? You can wave, nod money, I mean, throw money, fix your hair, whatever it will communicate that you buy into that. You can type Y or dollar signs into the chat. That would be great. Excellent. All right, so just those are our learning community guidelines as we go forward. Okay? Excellent. Excellent. Thank you, Tonya. I greatly appreciate it. All right. So I'm going to share my screen again. Now, we predominantly have two goals and a couple of learning objectives. One, and this is one that I'd actually like us to take a moment and discuss, is to normalize heightened affect or feelings as part of human interaction in the health service environment. And we'll come back to that in a minute. The other is to practice, adopt, consider ways of being or methods of communication that can prevent possible escalation or can responsibly, in the moment, decrease conflict and possibly even promote collaboration. So ultimately, those are our broader goals. And I'm going to stop sharing my screen for a minute, and I want to go back to the first one. And I'm going to make a statement in regard to that, and then I'm going to invite anyone to unmute who may want to comment on this. And Tiffany, Tiffany V., you can pass. I'm going to make my statement that you can pass if you want to, or you're willing to unmute. I leave it up to you. As everybody, if I invite you to comment and you don't want to, by all means, just say pass. Or give me a thumbs down, whatever works best for you. Some people are visual communicators. And the question, Tiffany, is this, and hopefully we'll hear from some other people, too. Is it fair to say, and I'm just asking for like a reality check, is it fair to say that within the frame of a social service environment, whether you're providing those services digitally, whether you're providing them face to face, is it fair to say within that frame or those frames, whatever it may be, that folks who are seeking services or receiving services, frequently, frequently, and I think that somebody is unmuted. Yep, there you go. Perfect. So is it fair to, not at all, is it fair to say that folks frequently come to the service provision arena in a heightened state of affect or having feelings about it? Is it fair to say that? Or do you completely disagree? Okay, Lisa's given me a thought. Thank you, Lisa. I get it. A thumbs up. Tiffany, what do you think about that? What do you think about the idea that folks come to that setting often in a heightened state of affect? Anything that you'd add? Any thought that you'd, and Irene, I think you agree as well? Maybe, maybe not. You'll let me know. What do you think, Tiffany? I would say that I agree. People have feelings about a lot of different services that they're coming from. Maybe this might be the first time they're receiving services. Maybe this is the first time that they've actually had anybody engage them in like resources or a listening ear. Or if they're coming for medication assisted treatment, then sometimes there can be like stigma that comes with that and they can have big feelings about that. And then just their overall like history, their family. So yeah, I would definitely agree with that. Okay. Okay. Thank you. Yeah. And Annabelle also is giving a thumbs up in regard to that as well. And Lisa, would you add anything? Tiffany, thank you so much for starting us off. Lisa, would you add anything to what Tiffany said about this idea that, yeah, go ahead, Lisa. I think very often that previous experiences in healthcare lend to this heightened sense of what are they going to encounter when they come in? And I don't think it's only among substance use disorder treatment seekers. I think it's for everybody, whoever goes to a doctor's appointment or any kind of health appointment. Yeah. Yeah. And you know, I'm going to use this word, Lisa, and tell me if you're okay with it. The idea that the person comes to that moment, maybe with Tiffany, with their whole history of how they've maybe experienced or received services before. Absolutely. And I particularly avoided the word baggage. I really wanted to say history because it could be very complex, their history. Yes? Absolutely. Okay. Okay. Great. Lisa, thanks so much. And maybe Annie, anything that you would add as well? I was just going to raise my hand. I must have read your mind. I think sometimes it's very hard to ask for help anyway. And sometimes there's a shame element to it. And so people coming in asking for help might not be comfortable doing it anyway. And again, a stigma around any kind of help, no matter what it is. Yep. Yep. Yep. Yeah. And certainly, you alluded to this, Annie, you didn't say it, and I don't want to add something that's not there, but it also made me think that a person, in addition, might feel vulnerable. Absolutely. Do you accept that? Yeah? A hundred percent. Okay. So I just want to ask, before we take a quick look at the objectives, I just want to ask folks, and anybody who would like to unmute or put this in the chat, and Jenna, maybe you'd be willing to respond to this. It's up to you, though. Why do you... What is my rationale for pointing this dynamic out at the beginning of this conversation? What is my rationale for pointing this dynamic out, that people may come to care with the history that they've had, with a whole range of feelings? What is my rationale? Or I'll put it another way. Jenna, why also is it relevant for us to consider that? What are your thoughts? So I think it just gives more insight and perspective. And a large thing, I feel like, with de-escalation is understanding that other people might come with things, and then they can put that on you, but that's not meaning that they're attacking you. So it just gives people a little bit of perspective. It gives us perspective for what the client might be going through, for why they might be a little bit more emotional, or angrier, or more frustrated with us. It could just give us a little bit of context for that interaction. Yeah. And you know, it's interesting, you didn't use these words, but tell me if this captures it also. And I'm linking this kind of what Talisa was saying, too, is that it kind of can give us a little bit of perspective that it's not personally directed at us. Exactly. Yeah. I mean, it doesn't mean we're not getting it, but it's, they maybe don't know us, so it's maybe not personally directed at us. And then I feel like usually a good way for us to kind of go with it is just to normalize and validate how they've been feeling, and to kind of show that they might not be treated here the same way that they've been treated somewhere else. Okay. So I want to underline something that you just said, and then Michelle, maybe we can come to you because I think you were going to add something. I could be wrong, I could be wrong, but you may want to comment on this. I just, I just want to underline that you've already started to cross into a strategy of de-escalation, which is the idea of communicating to that person, that we hear them where they are. And that's different than being defensive about how they may be coming at us. So I just wanna underline that as kind of the beginning of a strategy. Michelle, any thoughts about why I might suggest that we consider the fact that people are coming to care possibly with escalated or heightened affect? I think a lot of what Jenna said, but then a lot of it, which I think plays into some other trainings we've done, which is like looking at everything with like this trauma-informed care lens. And also not even just necessarily the patients and the people we're interacting with, but like how, what they're doing might trigger our like your own reaction and trying to like take that into consideration as well when you're like, when somebody, if there's someone at the front desk is yelling at somebody, right? Like that could trigger something within themselves and then sort of preparing and trying to take a step back as opposed to the initial response, which could be like, people could just have a fight response because that's a natural, you're gonna have a fight or flight reaction at times. Yeah, and Michelle, can I ask you a quick follow-up? So in regard to what you said, and I really appreciate you mentioning sort of a trauma-informed perspective and I'm sensing that's another conversation you've probably as a learning community had. What would you, what's your takeaway from that about how that relates to de-escalation? Well, I think it's how you approach like what's happening there. So I think for some people, they might, if you're not like thinking about how their trauma and also your own taking into consideration, sometimes it like you'll avoid a situation and you won't deal with it or you'll like rely on somebody else. And I think it kind of just, it can play into that in that way, I guess. I don't know if that's answering it, but. Did I freeze or did you? I don't think I froze. Did I freeze? You froze on my end, but did I freeze? Did I, no? All right, well, I'm keeping my fingers crossed that the internet holds out. Okay, so, you know, Michelle, I also wanna underline, you've said something twice that I think needs to be repeated a third time and needs to be underlined, is you've said you also can be aware of your own response to what's going on because you're a human being in the moment too. And I really appreciate what you described. You know, let's say you walk into the lobby and you hear somebody yelling at somebody else. Well, guess what? Just like Lisa mentioned earlier, that the patient or the client has a history, we also have a history. And that history is gonna impact how we might reactively engage in that situation. And of course, we want to intentionally engage in the situation, not reactively. So, Michelle, thanks for also putting that on the table as well. The idea that we come into the moment with our sort of history, what's happened five minutes before, what we're facing later in the day. Okay, I'm gonna share my screen again because related to what Michelle said, there's a particular learning objective that I wanna make sure that in addition to this idea that we know we can assume, and this is not a bad situation of making this assumption. This is an effective way of making this assumption. We can assume that if somebody is logging into that meeting, that client meeting, or if they're walking through that door or if they're waiting in that lobby, they could be already in a heightened state. There's one other thing I wanna add to that as a primary message for us to be thinking about and framing this conversation. I'm gonna share my screen again. And what I'd like you to pay attention to at this particular moment is the fourth bullet. Identify and commit to two self-care actions. I'm gonna repeat that. And this is one instance where I'm gonna read the slide bullet to you. Generally, I don't do that, but I'm going to intentionally do it. Identify and commit to two self-care actions. I'm gonna stop sharing my screen. Now, somebody, please, what are your thoughts about why I have purposefully read out loud twice now to you that fourth bullet? And how does that relate to the topic of our conversation? Hi, this is Josephine Velez. Go ahead, Josephine. Yeah, great to see your picture. You're very welcome. I like that. Self-care is very important, one, for yourself to keep you in tune with your emotions and everything. And two, it helps you keep in line when the patient or the person is escalated. It keeps you from becoming escalated. Okay, so Josephine, thank you so much. And also great to hear your voice. And the idea that your wellbeing and your state can keep you from becoming escalated. And Josephine, could I ask a quick follow-up to you particularly? I'm sorry, repeat that? Could I ask you a quick follow-up question? Of course. Okay, so my follow-up question is this. Is this a fair statement to make? That if you're feeling crispy or stress for whatever reasons, it is possible that you may not be as effective at deescalating a situation. Is that a fair statement or have I gone too far? No, that is a completely fair statement because to be honest, even the most best trained person, if they're stressed themselves, may not be able to communicate effectively or deescalate effectively. Yes, yes. So absolutely. So I wanna make something very clear, folks. The whole frame of this conversation and the use of these tools and skills are really dependent upon how are you doing? Where are you at at this particular moment? And what do you need to be in a position similar to what Josephine just said? And thank you for adding that, Josephine. What is it that you may need to be in a position to be as effective as you possibly can? Go ahead, Jamie. Go ahead, the floor is yours. Yeah, and by the way, folks, and Jamie, thank you for being so gracious and raising your hand to say something. What I wanna invite everybody is if there is a comment you wanna make or something you wanna add, don't hesitate, if I'm in the mid-sentence, don't hesitate to unmute and say, hey, Paul, I'd like to add something here. Don't hesitate to do that. What I would ask though is if when Jamie has the floor, please don't interrupt Jamie or anybody else. Go ahead, Jamie, the floor is yours. Yeah, don't interrupt me. Oddly enough, one of something my sister-in-law, who is in the education field, told me many years ago that really stuck with me was be the thermostat, not the thermometer. And it has truly carried me throughout my many years being in this field. And I think I've said this in another training that de-escalation isn't as scary for me. I think I find myself like that's one of my strengths because of, partly because of keeping that in mind. It's what I'm bringing to the situation. And so I think that sort of plays into self-care is because if we don't follow up with self-care after an incident, that those negative feelings can really like fester. And it allows us to then bring that into the next situation where you need to de-escalate. Absolutely, and I would go so far as to say, Jamie, and tell me if you would agree with this. And if you don't, please tell me you don't. I would go so far as to say that what you just described also part of the process of de-escalation is that even if you step in and de-escalate the situation and it's very successful, quote unquote, you've still been exposed to everything that was going on during that de-escalation. And you've internalized that to some degree and it has to be addressed in order for you to be prepared for the next time you may be called on. Jamie, would you agree with that or? Absolutely, regardless of the outcome, your amygdala is. Yeah, so no, I definitely agree with that. Okay, so I just wanna be very clear folks and Jamie, thank you for adding that. And I hope Jamie will confirm in the chat that I neither spoke to her before this conversation nor did I pay her to say what she just said. But there, and I'll let her confirm that in the chat, in writing, but the reason that I very much appreciate, baby, she says, okay, I think I know what that means. The reason that that's so critical folks is because that's related to the process of de-escalation. And Jamie prompts me to wanna ask a question of the learning community. Kind of take a quick poll of the learning community. And that is this, and I'm gonna answer this question myself too, I'm gonna raise my hand after I say the question. The question is this, have you ever been called in to de-escalate a situation? You know, you got that knock on your door or somebody rang your phone and said, hey, Michelle, we need you at the front desk. And you went down there and you de-escalated. So have you ever got the knock on your door or somebody, they brought somebody to your office, you went and you de-escalated or you de-escalated in the moment, and then you went right back to work and just continued with your day. Has anybody ever done that? If you have, raise your hand. I have, and I see some hands nodding, heads nodding. Okay, so, okay. So Shannon, you've done that as well. Okay, all right. I gotta tell you folks, that worries me. It worries me for all of us because it's cutting out a critical part of the de-escalation. And Jamie mentioned a part of our brain and, you know, our brain, body and spirit are all involved in de-escalation. So we are impacted by it and it requires addressing that impact in order to go forward, okay? So again, this idea of a process of de-escalation so that we can manage whatever we're exposed to. And again, the two broad messages that shape this conversation, it's normal and probably pretty much to be expected that when somebody is seeking services, getting services, there's a strong possibility that person already is in a heightened state. And two, your wellbeing is absolutely connected and linked to your effectiveness de-escalating, okay? Yeah, go ahead, Sharnice, go ahead, please. Hi. Hi. Thank you for being here. This is so informational. I just wanted to comment on the processing after a de-escalation. Yeah. There has been many situations while I've been here, you know, at CCHP, where as though we were called to de-escalate a situation. And you brought up the point of processing it after the situation happens. Yeah. And that goes on here, you know, our supervisors reach out to us, even other staff, our staff that are involved other staff, our staff members, managerial staff, you know, we all come together and they actually come to our offices and they ask us, how are we doing? You know, do you need to talk about anything? Do you need to process anything? Even something simple as maybe one of our employees that are no longer with us, you know, it's always a space to process things here. And you just really made me aware of how important that is. And I'm very fortunate that we do have that space here. Thank you. And if it's okay, can I ask you a quick follow-up? Sure. So first of all, thank you for letting us know that you have that space and that that's actually happening because that is a critical component to the process of de-escalation. And the follow-up question that I have, and this is a question specifically for you, if you'd be willing to answer it, because you're describing something that clearly, you didn't say this directly and that's why I wanted to follow up, but you said it, you implied it, that you get a benefit out of this debrief or processing it afterward. And I'm just curious for you because I'm so glad that you have that opportunity and that people are coming to your office and asking you how you are. What is the benefit you get from that? What do you get out of engaging in that processing it afterward, that debrief after an event? Yeah, I can talk about one person, a situation that recently occurred, but not too recently. Where as though a client of ours was acting out and irrational behavior and things like that. And from my perspective, it made me really sad. It made me really, really sad. It made me, it brought up past experience that I have experienced. And it kind of triggered some things inside of me that brought on feelings of sadness. And I was able to process those feelings with my supervisor and tell him exactly how the situation made me feel. And it was other questions that followed that. And it ended up being a whole conversation. And after that conversation, I felt so much better. It made me feel as though that I wasn't alone. Yeah, thank you. Thank you, Sharnice. And again, if there's one takeaway from our learning community conversation this first 90 minutes of it, please take away what Sharnice just said, that I didn't feel alone. And no one who deescalates should feel alone in that deescalation. Because that's where the cumulative, unprocessed, undebriefed impacts can start to harm you and harm your ability to work with your patients or your clients. So Sharnice, thank you. Thank you. And I really appreciate you answering that question so specifically. Thanks so much. So folks, I'm gonna share my screen again. And I wanna identify, just sort of lay out for you a couple of these considerations. And the first one in some ways is almost counterintuitive, which is that trying to reason with somebody who's experiencing high affect, and clearly I've taken a strong position on this because the sentence says is impossible and impossible is all in caps. So I'm asking you to consider that, that the idea that when someone's in a heightened state, using verbal reasoning with them or education or sharing the guidelines or the rules are probably not going to be the most effective strategy. And I wanna go back to what one of our colleagues said earlier, that in that moment of heightened affect, communicating to the person that we hear them and that we're with them, we're present with them is probably more effective and that can achieve the second bullet, which is the goal is to reduce arousal, to help that person's affect to sort of come back down to baseline if possible. So that actually maybe conversation is possible. And it's funny because sometimes it can be very easy to get caught up and I'm making a generalization here and I wanna own that, that we can get caught up in the idea that, well, if I just explain it to the person and actually the explanation can actually escalate the situation. So the goal is reduction of arousal, not reason or explanation. Also keeping in mind, and this was referred to earlier in the beginning by one of our colleagues in the learning community, that human beings, when they're in stressful situations have four basic human reactions, that it's bite, flight, fawn, which is that the person will sort of, yes. Yeah, go ahead. I'm gonna, I'll stop sharing my screen so you can make your comment. Go right ahead. Did somebody wanna ask a question or comment? Yeah, go ahead. And I don't, yeah, go ahead. I'm not exactly sure how to pronounce your name. My name is Jose, you can call me Jose. Okay, thanks Jose, go ahead. Yeah, I was in a situation where one of my supervisors told me not to do something and it escalated like really bad, really bad to the point that the person wanted to wait for me outside and everything. And the sad part about it was another peer came in and intervened and I didn't get the support that I needed from my colleagues, which what I'm hearing here got me happy, you know, that I would get the support here. And it's nice to hear that. But getting the support is always important. You know, when I was in class, they always told me you have to unwind when you come home, because there's a lot of things that happen in the work field. So you have to unwind, have a place or something to unwind. And in situations like this, it's very important to come together, whether you're in the situation or whether you're after the situation, you know, always come together and support one another. You know, it's very important. Agreed. You don't want to take that home. And what I'd like to throw out for consideration, which is building on what you're saying, is that that unwinding or that letting go of what happened, that processing, yes, it can certainly happen at home. I'd really also like us to all consider that it can be part of the de-escalation process in the work setting. Because who can, how effective are you going to be if you have to wait until you get home to sort of, and I'm going to use your word there, unwind, let go, process, sort of let it drain off, whatever you may be exposed to. And thank you also so much for adding that it can feel very isolating and painful if you don't have the opportunity to check in with colleagues. Because sometimes folks, let's face it, we have to set boundaries with clients. We have to give clients information or patients information that they don't want to hear. And they'll react to that. And we're the ones sitting across from them during that reaction. So absolutely, and we do need a place to be able to work that through, unwind it. Thank you. Thanks so much for adding that. And again, please follow the excellent example, feel free to just unmute if there's something that you want to say. I'm going to share the slide one more time just to simply say that again, keeping in mind these four basic human reactions that are fight, flight, fawn, or freeze. Fawn is when you can become, you can sort of, yes, somebody. Freeze, of course, is like the deer in the headlights. And what I want to say is when somebody's having any of these four, there's a lot of heightened affect. And PS, as one of our colleagues pointed out, depending on the state that we're in, we also can have these particular reactions or our own experiences, our past experiences can be triggered. And that's why having somebody to unwind it with at work, somebody who can help us identify, oh, this is how it connects to me from my past. And this is what it's brought up for me, the countertransferential elements of it. It's very common in human service work to have countertransferential reactions. It doesn't mean you're not a good worker or a good clinician. It simply means you're a human being in a situation. And we all get exposed and have reactions. And then the last thing I just throw out for consideration is that de-escalation actually, the process of it can actually be very unnatural because for some people, now there may be people in this learning community, and I've been in other learning communities where people have said, well, I disagree with that statement. It's not unnatural. And what they've identified is that it's not unnatural to them because they do it so often that it's become second nature. And what I'd like to throw out for all of us to consider is that in order to be effective at de-escalation, it actually does require practice. And certainly the practice of actually doing it and then reflecting on that practice and practice where it's not an actual or real life situation and that you can then in a safe environment, walk through, work through what you can do, how you can respond. And the goal of that practice is so that it actually does become second nature that you could be aware of, oh, I'm having a reaction to this. I can manage that and still use my training, my practice and my skills to de-escalate the situation. So just throwing those few points out for consideration. Now, I've said this already, but I wanted to put it in very big, bold type that de-escalation is a process, it's not an event. The second time I've read the slide exactly the way it's written. Again, that process has a before, a during and an after. And it's a circular process because we don't just de-escalate once in our careers, we may escalate quite frequently. And before we walk through these steps of before, during and after, I'm gonna stop sharing my screen for a moment and I'm just gonna ask a poll question. And it's a frequency question. And you can use the chat to respond to this. So on a scale of one to 10, one being I probably de-escalate the situation zero to one time a week, that would be number one. Five would be at least five times a week. And 10 would be five times a day or more. So on that scale of one to 10, how frequently do you actually de-escalate? So we have a four. And let's try and hear from as many people as possible. And I'm asking you, yep, five at different levels, understood Jamie. Six, okay. So I just wanna note that the lowest number we have so far is a four. Okay, so Irene says one, not very often, okay. Five, often referred to as the Switzerland of frequency because it's right in the middle. Ben says one, Trezor says three, okay. And again, let's try and hear from everybody if we can. How frequently? One, five, okay, three, okay, all right. If you haven't yet, Tiffany says three, five, three, two, okay, five, got that five and one right next to each other. It's visually striking, okay. So it's interesting because there's some people that de-escalation is fairly infrequent. Excellent question. In this instance, we're talking about work de-escalation, but I appreciate acknowledging that you're probably practicing those skills at home maybe as well, certainly with maybe with a toddler. Well, we do work with toddlers here. So my one, that's probably what, yeah, that's, so we have a free childcare when you're like accessing services. So Blanca and Irene, I'm assuming that's what they're addressing, yeah. Yeah, I would just say, I think that Irene and Blanca may have put a lower number than is accurate because they're so used to doing it with children that they're very comfortable, but also recognizing that we hear a lot from the clients when they're dropping off and picking up their child. And we have special techniques to help that transition for their child out of the playroom, but it also helps the parents. So, you know, when we give the kids their graham crackers, that signals it's time to leave, but it's a kind of a positive way to end the visit for everybody, so. Yeah, so again, a beautiful example, Thea, it's like a sweet way to conclude, and I mean, sweet tasting, but sweet as well, sweet way to conclude that the end isn't a bad thing, it can have a good side as well. And Thea, I also just want to underline, I love the fact that you were like, I want to make sure that they get credit for the amount of de-escalation that they're doing, because they're probably doing more than they know they're doing because it's become second nature, it's just part of the work, and it's still de-escalation. Yeah, excellent, okay. Yeah, and Blanca says in our play, absolutely. Okay, so I want to ask, I also, thank you for that clarification, and I also want to just ask one other question, which it's not actually in this slide deck, it used to be, but we removed it, but given our conversation, I want to ask it, it's a confidence question, and I'm just asking you to rate your degree of confidence at this moment. And I know that some people may put in the chat now, I want to acknowledge that, that your confidence may be different in a different situation. So like Thea just described, in this playroom setting, our colleagues might feel highly, highly effective and confident in what they're doing. In another setting, if perhaps they were de-escalating their parent or an adult, they might have a different level of confidence, but I'm going to ask you to just assess generally at this moment on a scale of one to 10, one being, I don't feel confident at all, and 10 being, yeah, I feel very confident. So let's get a sense of where people feel in terms of their confidence de-escalating a situation. And again, I know we're going to acknowledge the caveat of, it depends. Drew says 7.5. Jamie says eight, eight, nine, eight, seven. And there's no right or wrong here, folks. This is just an opportunity for you to self-assess. How confident do you feel? Lisa says nine, okay. Okay. Zobedat says eight, okay, excellent, wonderful. Pejour, seven, okay, good. So again, I'm just asking you for your anabelsis five, okay, also sometimes referred to as the Switzerland of confidence, right in the middle, excellent. And of course, confidence can depend on the situation. It can depend on the day, but we're just, and Riley says seven, just asking generally if you were doing a quick sort of assessment today. All right, all right. So I'm going to share my screen again, and I just want to walk through. What I've identified is a couple of steps that you can consider in terms of this beginning, middle, and end, before, during, and after sort of scenario of the process of de-escalation. None of these are going to be novel or new for anybody in this learning community. So before you're in the position of de-escalating, you can actually plan, you can talk with colleagues, you can consider these are some of the scenarios or some of the hotspots in our setting. And again, those are the things that you can identify already. Of course, there are going to be things that happen that you couldn't or didn't plan for, but there are things that you know, or there are situations, scenarios, or places within your setting that you can actually make a plan about. You can also plan as to who's going to be involved. What's the process amongst the staff so that nobody feels alone. And then once you have that plan, you can actually prepare. You can figure out this is how we're going to do this. This is how we're going to carry it out. And then you can practice the plan. Even if you just decide it's a mock situation, let's just walk through how we're going to play this out, see how it goes. And you can also prepare before walking into or going to or opening your mouth to de-escalate a situation if indeed you're going to be speaking. So let me just say a little bit about what I mean by that. I one time took a wilderness safety course, and I don't know if anybody else in the learning community has ever done that, but one of the things that the trainer told us is in wilderness safety, and I think this is relevant to de-escalation, in wilderness safety and wilderness first aid, if you are going into help, you don't want to create additional victims, including yourself. So the preparation before is taking that time to sort of assess where are you at this particular moment? What's coming up for you as you walk into this particular situation? And again, it's a moment so that you can walk in and access the skills and not sort of get caught up in a dynamic that could be happening. Then after you've de-escalated, you actually are engaged in whatever that de-escalation might be. And then the idea of seeking support and debrief or processing it afterward, that again, maybe your plan is that somebody on the team comes to you, maybe you go to somebody on the team, maybe there's a team meeting about it. And then you individually, as well as in your team or with your supervisor, reflect on it. And you can revisit the plan and adjust it as your experience grows and as you find other situations coming up. So again, thinking of de-escalation as this before, during and after process. I'm going to stop sharing my screen. And just ask if anybody has any thoughts or reactions to that sort of way of thinking. Michelle, any thought, any reaction to that? Yeah, well, because I've been thinking a lot about it because how people's reaction is, I think it's different because there's the people, right? When you're working on site, but then we have a number of staff that do outreach that escort patients to different meetings, appointments and things like that. And that, like how you're going to react to something is going to be very different because you don't have, like here, I mean, when something gets, if you're trying to de-escalate and it's not working, you've got security, you've got managers, you've got all of us here to like continue to support and thinking about when you're out in the fields, like you don't have all those other resources. So essentially, usually, I mean, the peers and stuff, like they're on their own with the patient. So if something happens or they don't even have somebody else, when we're doing outreach, we purposely send two people a lot of times for that situation if something comes up. But, you know, thinking about putting practices, putting things into place, especially when you're on your own or when you're just like two people, like kind of like surveying what's like around you if you need support in some way. So thinking about that, I thought was coming up in my mind during this. Fantastic. So again, it's looking at what you're already doing and then seeing how can we like build a plan that creates a connection for these folks because they're doing something very unique. Mm-hmm. Fantastic. That's great. And that's why we're here. Jose, yes? Go right ahead. The floor is yours and then we'll go to Tiffany. Go ahead. No, whenever I support someone and I'm alone, I usually have the flight on my, if there's a situation, I would not try to engage too much depending on the place I am, who I'm walking with, what neighborhood it is, if it's this neighborhood, if, you know, if it's a dangerous neighborhood I'm walking into. You know, I always take that in consideration to see the reaction. And the peer, of course, we get to know them before we go with them. So I pretty much know how they're gonna react to any situation. But in case of a danger, the best option is to just depart from the person and if he follows you, you always have a cell phone, you know, and just call, you know, don't hesitate to call. The best option it is to walk away. Yeah. Thank you, Jose. Jose is saying something that I wanna underline as a process for all of us to consider, because I think the way you said it was so clear. Part of that moment that you take for yourself before you actually deescalate, and I think, Jose, you described it beautifully, is you are doing sometimes a safety assessment. Where am I? Who's around? What depth of engagement should I engage in that's gonna keep everybody safe in this particular moment? And that's part of what that preparation just before is, because you are making decisions that are gonna touch on and have implications for your safety and the safety of the other person. So, Jose, thank you so much for kind of sharing like the mental process and the assessment that you do before you engage, and sometimes it is in, you do that in seconds. You do. What I want to be very clear though, is I want all of us hopefully to walk away from at least this part of our learning community and conversation with, go through that process. It's for your safety. It's also for the safety of the other person and the safety of the people around them. And primarily it's for your safety. Tiffany, the floor is yours, and then we're gonna go to Shannon. Jose, thank you for adding that. Yeah, go ahead, Tiffany. Thanks, Paul. No, I just thought that it was really important when you bring up like debriefing after, right, because sometimes people don't have that space, whether it's like with a client or even with staff members, right? Like, definitely sitting down and talking things through to kind of gauge where you're at, how you're feeling about a situation. And right, you're able to gain some clarity from that, I believe, when you're able to reflect or debrief with someone about what has just occurred. Fantastic. Thank you. Thank you. And I also want to acknowledge, and I know this is going to be unique for each setting, and Shannon, Jenna, don't lose your thoughts. I just want to acknowledge that what I'm inviting you to consider is you can create the plan, you can create the structure that's going to work for what you're actually doing. Because you're thinking about these are the components that the plan can include, and this is how we tailor it to fit our unique situation or settings like Michelle was referring to. Shannon, the floor is yours, and then we're going to go to Jenna. Hi, thank you. Great to see you, too. Thank you for this. This is so helpful. Being part of the outreach team, you know, it's like Michelle said, is a very unique situation, a unique position to have, especially when we're talking about de-escalation. Because for me and my role personally, often the people that I'm interacting with the outreach are not patients or clients at CCHP. So oftentimes I'm, and the rest of the outreach team, are interacting with people that there's no prior rapport with. So, you know, talking about the other community members, or even individuals outside of our community that we generally outreach to. Yes, and they're unknown, basically. Yeah, so one thing that, you know, I want to echo what Michelle said is that unique plan of, you know, not letting people go by themselves when we do outreach. When I'm coordinating the outreach, making sure that we're all, like, always assessing where we are. And also doing, like, checks with, like, who we're with. Like, I'm doing checks with my colleagues who are involved in outreach with me. You know, and also being aware, okay, if my colleague's uncomfortable, you know, as the person who's supervising that, like, how do I step in? Or if I'm in a situation where I'm uncomfortable, my team is really good at assessing that and, like, okay, you know, jumping in where, you know, someone doesn't feel alone in that situation. Yep, thank you. And again, I'm going to say this now, Shannon, because you inspire it. It's later, and it's much later in the slides, but I want to say it now. No one de-escalates alone. No one de-escalates alone. And you couldn't have made a more realistic and powerful case for why that's critical. Because if you're in the field and you're interacting with people who you don't know where they're coming from, you don't know what situation or what reactions they may have, you have got to be able to rely and have a connection to the people that you're in the field with, and everybody has got to somehow be connected. And again, what I'm suggesting through this conversation is that we're proactive about that, not reactive about it. That we intentionally think through those things as much as we can, as much as we can. Janet, the floor is yours. Yeah, that kind of feeds into what I was going to say, too, because, like, for the counselors, we don't always, like, see the climactic event. Like, sometimes we get a call, and so we do have that moment to kind of prepare beforehand, and I think that's also going back to how if we're not doing well, then it's a lot harder to de-escalate. But being able to kind of, it is a little bit of a privilege to be able to take that moment and recognize, hey, am I in the space to be able to handle this now? And if not, we do have other colleagues, thank God, who are very supportive and could maybe help you out a little bit in that moment. And it's just cool how you can have that little kind of moment to yourself and see, hey, am I prepared to kind of go and deal with this right now in the most productive way? Yeah, yeah. Or to see if you can have someone go with you and, like, come and support with you, yeah. And if you can get what you need in order to be able to do what you're being asked to do. Yeah, exactly. Yep, yep, yep. Sharnice, the floor is yours. Yeah. Hi. You know, as it relates to, you know, escorting clients and taking clients out, what I found very, very useful and very, very helpful is, you know, taking a client to their local HRE office. And, you know, sitting down, having a conversation with this client ahead of time and being honest with them and letting them know the potential worst outcome of our visit. You know, a lot of times we get there and people on HRE has not done their job relating to either processing client information or putting. And the outcome is the client may not get their benefits for that money. And they're very upset. You know, they rely on their public assistance to pay their bills and to even things that, you know, things of that nature. And we get there and they find out that it wasn't something done on our end. It was something done on HRE end. And, you know, they become very, very upset. But the first thing that I tell them is that when it has happened, when that situation has happened on many occasions, I'll look at the client and I'll say, okay, remember we talked about this and we're just going to get what we need from them. And we're going to get a date and we're going to get all the forms and everything just in case we have to file, you know, any papers as far as a fair hearing or anything like that. But I'll make it aware of, I'm very honest with them, very upfront. This may not go our way today, but we can go in and we can find out what exactly is going on. And they better, you know, they get a better understanding. It's not that I'm telling them, oh, things is just messed up. No, this may can happen. And by giving them, you know, giving them a heads up and saying, okay, this may happen. This may not work out in our favor today. But let's get the information what's needed from them. And normally it works out just fine, you know, because the client is already aware that this may not go, you know, this situation, it may go our way today and they may process the paper today, or it may take a couple of days for them to process the paper. Yep. Yep. Yeah. And, you know, Sharnice, such a beautiful example of how that heads up, that preparation, when the person's not escalated, the preparation before helps that person because let's face it, if they're in that situation and someone's saying to them, you know what, you're not getting your check today. I mean, my thermometer just went up. I mean, and I would imagine, Sharnice, if I were you and I were the worker sitting there, my thermometer might go up just as the worker too. So, there's an additional thing that I just want to put a label on that you described beautifully, but I just want to put a label on it, which is that you communicated before, during, and after that you were a collaborative partner with this person. You've given them the heads up. You've assured them that you're with them and you're working with them on this. You're with them in the moment of their escalation, and I'm going to put it this way, in the moment of their disappointment or their anger about the situation, and you're still affirming, we're working together to solve this. So, that affirming to the person, I'm here with you, we're collaborating on this together, can be a powerful way of helping that person to re-regulate because let's face it, folks, they feel less alone. They're not left dealing with this on their own. They have Sharnice, who is their advocate with them. Who's escorted them there. We have about 11 minutes left to our time together today, and I'm very much looking forward to our next 90 minutes. And there's something in particular I'd like to leave you with for today, which is a scenario. And generally, there's something that I cover before this scenario, but I'm going to postpone that until we meet next time. But I just want to share this scenario with you, and I want you to be thinking about how you might respond to this scenario, and we'll start our part two with this scenario. And there'll be plenty of time for me to share this four-part framework that I want to share with you. But given what we've talked about, I really would like to share this scenario with you, and just get your basic reactions to it. And then we're going to talk about it in much more depth when we come back next time. Okay? So I'm going to advance the slides to that scenario, and I'm going to let the computer read it to you in a voice that will sound eerily familiar. And here is the scenario. And again, I'm going to let the computer read this to you. You can read it yourselves. And then I just want to get your general reactions. And maybe if it's possible, if there's time, maybe five people would be willing to unmute. And anybody who wants to write anything in the chat, please do. But maybe there'll be five people who'd be willing to unmute and just share their general reaction. Keep in mind, there are three characters in this scenario. There's Jody, who is the client living at this woman's transitional housing program. There's Andy, who is her boyfriend, not living there, but visiting. And then there's Dave, who is the staff person. And essentially, we are Dave. All of us in the learning community are Dave. Okay? I'm going to let the computer read this to you. You've probably read it already yourselves. But I'm going to let the computer read it to you again, and then I'm going to ask for five people to just unmute and share their reactions to it. Jody is a client in the women's transitional housing program. It's Friday night, and her boyfriend Andy is visiting her in her room. Andy is still visiting, and it's past the required curfew time. Dave, the staff person on site, knows this is against the program guidelines. He's concerned about going up to Jody's room to ask Andy to leave, because Jody is known to cause a scene. So far, it's been a quiet night, and Dave wants to keep it that way. So, five, just whatever your general reaction. And Lisa, if you don't mind, would you be willing to unmute and start us off as five general reactions? What's your first gut reaction? If you're willing. Are you willing, Lisa? I'm willing. Okay, great. What's your... So, regardless of the fact that Jody may react, I have a responsibility in my profession to maintain the rules. And so I have to be willing to deal with whatever's going to come as a result of it, but I am going to go to her room and tell her that it is time for him to leave, and just have to manage whatever comes after that. Got it. Got it. Lisa, thanks for starting us off. Jose, go ahead. The floor is yours. I would start with a friendly approach. Listen, I understand that you want to spend time this Friday, and this is a place that is not permitted. You know that. And I wish, I wish, I really wish I could have it your way, but if I do, I could lose my job. You don't want me to do that. You know, it's, I think it's best for us both that he leaves and come tomorrow. And, you know, see how he reacts and how she reacts. But I think the approach is the response. You know, the way you approach a person is the response you're going to get. If you go like with authority to a person that you know that doesn't accept authority, then you're going to have a problem. So you're going to want to go to a person that feels that way. All right, letting them feel that he has the authority, but you have a duty. Okay. Listen, I understand, you know, it's good and dandy this Friday. He has a good old body, but not today. Please, I can't. I'm so sorry. You know, that's the way I would approach it. Fantastic. Jose, thank you so much. Lisa, did you want to add something else? Well, I just want to say that my response to your question was just that I would have to address it. I did not say how I would address it. Understood. Understood. And thank you for clarifying that because you and Jose are kind of setting the stage of what needs to be done and then there's how I'm going to do it. Yes. So thank you for that. Can we hear from three other people who might be willing to unmute and comment on a reaction that they have to that particular scenario? I'm not sure. Whoops. Yeah. Go ahead, Blanca, and then we'll hear from the next person. Go ahead. I'm not sure if maybe the way it was like the way I read it, it made me feel like almost he was expecting something to happen because he knows from a past situation that she had to ask that she escalated. So I see why he would want to be cautious about approaching. Of course, he has a duty to do what is for the rules. But in case of it's almost like he's anticipating the escalation and kind of thinking about what is he going to have to do. But again, it's like I almost want more context to see like where or how to like actually approach the situation. Okay. Okay. Excellent. Thank you. Thank you. Thank you, Blanca. And who? Yeah, there was somebody else that unmuted. Yeah, Michelle and Zobedet as well. Go ahead. Yeah. So I was thinking like, especially when you're looking at somebody who's in like transitional housing, like that they sometimes don't have a lot of supports. So I would almost say like starting the conversation with like, I'm so happy you have somebody here to support you while you're like in this housing, like in this and saying like, we're so this is really great that you have this person. But unfortunately, we have some rules in place. And so why don't we schedule and make it that they come back again so they can continue being there for you, but sort of like reinforcing like this is really great. You have somebody here. Okay. And we want to we want to like continue that and like manifest that for you. And like, but we do have to follow the rules. So let's figure out that when they can come back. So you can continue having that support you need in this process. Fantastic. Fantastic. Zobedet, go ahead. Yeah, please. Yeah, just just a comment on the rules that, you know, there's nothing a vacuum. So I'm assuming there are protocols. And I'm assuming that if that person is really known to create the scene. So maybe in the beginning say, Hey, remember, there are protocols here. Okay. So we want you to be happy. But the issue is that, you know, just let's really follow the rules. So I think that conversation is going to be easy. When you go up and say, Hey, hope everything is okay. But you remember that we have rules here. So I think that's a different conversation that say, Hey, you need to leave or something. So I think having that system in place, and taking a precaution, knowing that there's a high risk of having escalate. That's, that's an easy conversation to have. Okay. Okay, thank you. And, and Tiffany, go ahead. We're going to give you the floor. And then I'm going to ask you to ponder something until we see each other next. Go ahead, Tiffany, the floor is yours. Just thinking of what everyone was saying, as when you said earlier, I think it helps when people are able to prepare before and after, right? So like, if you know that this person has a history of acting this way, then preparing the person even before, right? Or yourself even before because you can even go up 30 minutes before it's that time, right? And it's not this like cutoff where it's like, Hey, you guys got 30 minutes left. I'm just letting everybody know, whoever's still here, you have 30 minutes left, so that they're prepared to say goodbye in a short amount of time, right? And may be more susceptible to, it's the rules and it's time to go. As opposed to this like abrupt, it's nine o'clock and it's time to leave. Like this moment. Yep. And again, Tiffany, I think you're connecting to what Zobedet was saying that this idea that there are protocols and maybe we've reminded everybody 30 minutes before. And I will throw out not to complicate things further. And I do want to just touch base with Jamie because Jamie wrote in the chat, gives the client the power to control their emotions. And Jamie, I wonder if you'd be willing to elaborate on that. But I want to throw out, and I'm not trying to make things harder, but I want to throw out, we, Dave, we did everything to let the person know. We let everybody know that 30 minutes was and Andy's still there. So we did it. Tiffany, we did it. Zobedet, we did it. We followed the protocol, but he's still there. So Jamie, do you want to elaborate a little bit on what you wrote there? Yeah. Well, so I originally wrote this for Sharnice, but it also does apply for this. I think setting the client up for success and not failure. And so giving them that heads up allows them to just be prepared to whatever feelings that they're going to feel. And that it's not a surprise and that they're not going into something blind. They have that time to process those feelings. Yep. Yep. And sometimes we are absolutely able to do that. We are able to foreshadow or give a heads up or prepare. So it's not a surprise. And sometimes we do that and the person still doesn't like what it is. Yeah. I see Lisa. Yes. Right, Lisa? Yeah. So this is what I'm going to ask everybody to ponder. And trust me, this is related. It's not a non sequitur because I know we're at time. And I thank you so much for your participation. I'm very much looking forward to our next 90 minutes together. What I want you to ponder and we'll start our conversation with the scenario. But I want you to ponder and you don't need to answer this now. Is I want you to be thinking about what's most important to Jamie? What's most important to Jamie? And I'm going to leave you with that thought. Cliffhanger. And we will see each other next time. Thank you so much, everybody. What a pleasure. Very much looking forward to our next 90 minutes together.

de-escalation strategies

social service settings

managing emotions

proactive approach

structured process

self-care

stress management

emotional support

transitional housing

empathetic communication

hypothetical scenario

client priorities