Pic 40: The screen returns to Dr. Owens.
MI is helpful for de-escalation because it can strengthen relationships with clients.
Pic 41: This slide is titled “Motivational Interviewing” and contains the following list:
You can learn more about these MI techniques in the Supplemental Materials.
Pic 42: The screen returns to Dr. Owens. Next to her are the words “Calm” and “Assess.”
Let’s focus on two techniques for the Calm and Assess steps:
Pic 43: This slide is titled “Techniques to Calm and Assess” and includes the following information:
Empathy: Affirm, validate, or normalize the individual’s feelings and show them you understand.
Open-Ended Questions: Help the individual share more about their experiences and help you better understand where they’re coming from
Pic 44: The screen returns to Dr. Owens. The words “Empathy” and “Open-Ended Questions” appear next to her.
When an individual is frustrated, it's best to start with Empathy, then ask Open-Ended Questions.
Let's walk through a situation that shows how this model can work. Imagine you're starting a visit with this individual.
Pic 45: The screen transitions to a scene where Dr. Owens sits across from a middle-aged man with glasses.
Dr. Owens: Hi Frank! It’s nice to see you again.
Frank: Yeah, you too. Look, can we just get this started? I’m kind of in a hurry.
Pic 46: A screen with a symbol of two word bubbles at the top appears over the scene. It includes the following information:
This client seems agitated: short, curt response and impatient body language.
Let’s see how the provider can empathize (affirm, validate, or normalize the client’s feelings and show them you understand) and follow up with a question. This is the first step: Calm.
Pic 47: The screen returns to Dr. Owens and Frank, with a word bubble over Dr. Owens’ head. The speech bubble includes the title “Step 1: Calm.”
Dr. Owens: I can understand being in a hurry. Let’s jump in. Anything you wanted to chat about in particular?
Pic 48: The screen zooms in on Frank, who is pointing with his arm. There is a small image of a lightning bolt behind the text.
Frank: Well, to start with I couldn’t find a parking spot. Now I’m late, which means I’m going to be late for my next appointment. You need to tell people when the parking lots close!
Pic 49: A pop-up appears over the scene with an icon of two word bubbles, and the following text:
The individual has shared why they’re upset. Now let’s look at two example responses the provider can use:
Let’s see how the second response plays out with the patient.
Pic 50: The screen returns to Dr. Owens and Frank. Frank has his arms crossed. The words “Step 1: Calm” appear next to Dr. Owens’ word bubble.
Dr. Owens: I’m sorry that happened. I can understand your frustration.
Frank: Thank you. I, I appreciate that.
Pic 51: A pop-up appears over the screen with the following information:
Frank seems to be feeling a little calmer. Now let’s look at how open-ended questions can get at the root cause of his problem. This is the Assess step.
Open-ended questions help the client share more about their experiences and help you better understand where they’re coming from. Here are examples of the difference between an open-ended and closed question.
Closed question: “Do you have a solution?”
“Do you” encourages a one-word response.
Open-ended question: “What could we do to help next time?”
Open-ended questions start with how, who, when, where, or what.
Let’s see how the open-ended question plays out with the patient.
Pic 52: The screen returns to Dr. Owens and Frank. Dr. Owens is gesturing towards Frank. The words “Step 2: Assess” appear next to her word bubble.
Dr. Owens: What could we do to help next time?
Frank: I guess you could at least give us a heads up? So we can plan ahead.
Pic 53: A pop-up appears which reads “He seems calm now. Let’s see what a brief Facilitate step would look like.”
Pic 54: The screen returns to Dr. Owens and Frank. The words “Step 3: Facilitate” appear next to Dr. Owens’ word bubble. Frank uncrosses his arms.
Dr. Owens: That makes sense. I’ll talk with our receptionists and see if we can give folks a heads up.
Frank: Yeah, that would definitely help.
Notice how the client’s body language has changed to show they’re ready to move on.
Dr. Owens: Great. So, what brings you in today?
Dr. Owens did a great job and was able to de-escalate the situation.
Pic 55: The screen returns to Dr. Owens alone.
Sometimes, it's not possible to get to the point where an individual is ready to discuss next steps.
For some individuals there are aspects beyond the provider's control that could prevent accomplishing what you hoped in the conversation.
It might take multiple visits to form a concrete plan, and that's okay. The most important thing is maintaining a strong relationship so you can keep helping them.
Pic 56: A title card appears that reads “Dynamics, Safety, and Reporting” before transitioning to Dr. Owens in front of the blue background. The words “Dynamics,” “Safety,” and “Reporting” appear in bullet points next to her.
It's important to know about and consider preparing for dynamics, safety, and reporting. Let's take a closer look.
Pic 57: The screen changes to one titled “Dynamics” with an image of a shield with a star on it, and the following text:
An individual could see you as an authority figure and have difficulty relating to you or feeling understood.
Pic 58: This slide has an image of a figure with a no symbol over it.
An individual may have felt discriminated against in the past, affecting their relationship with you in the present.
Pic 59: This slide has an image of a heart inside another heart.
When this happens, try to understand where the client is coming from and show empathy. If the situation doesn’t feel like it’s improving, it’s okay to take a break, or pause the conversation for another day.
You can learn more about these dynamics in the Supplemental Materials.
Pic 60: This slide is titled “Safety: Best Practices.”
If there’s a possibility of physical harm, follow physical safety best practices:
If you feel uncomfortable or unsafe, you can always let the person know that you’d like to take a break and continue at another time.
You or someone from your office can follow up afterward to continue the conversation.
If you encounter a situation that leaves you feeling uneasy, make sure to reach out to someone in your office for support.
You can learn more about safety best practices in the Supplemental Materials.
Pic 61: This slide is titled “Document the Conversation” and has an image of a notepad and pencil with the following text:
Documenting can help you and others interacting with the person in the future better prepare.
You can learn more about documentation best practices in the Supplemental Materials.
Pic 62: The screen returns to Dr. Owens.
Remember, it's the conversation that's difficult, not the individual. Certain information or certain external factors can provoke strong emotions.
Pic 63: The words “Calm” and “Assess” appear next to her.
Now you’ll watch a provider working through the Calm and Assess steps with a patient using the techniques we talked about.
Pic 64: This slide is titled “Empathy” and has an image of a heart in a word bubble with the following text:
Affirm, validate, or normalize the individual’s feelings and show them you understand.
Pic 65: This slide is titled “Open-Ended Questions” with an image of a question mark in a word bubble.
Help the individual share more about their experiences and help you better understand where they’re coming from.
Pic 66: The screen returns to Dr. Owens. After a moment, the words “Provider’s Goal:” and a bullet point that reads “De-escalate the situation” appear next to her.
In this simulated conversation, you’ll watch a provider talk with a client, Kai. The provider’s goal is to de-escalate the situation for Kai and herself. We’ll stop before moving into Facilitate to explain how the provider did with the Calm and Assess steps.