Communicate respect and promote dignity. These positive interaction strategies are the foundations of Safety-Care® and encourage therapeutic rapport. We all know, in the field of human services, rapport is everything. Having rapport with fellow staff and individuals can be the difference between having a pleasant day at work and walking into an awkward nightmare. Rapport supports staff resilience, encourages a healthy working environment, complies with regulatory requirements, and helps organizations meet their obligations to the individuals served. With some individuals, rapport may be difficult to earn or difficult to maintain. Sometimes, the individuals we provide services to, may make the most “Zen” staff feel insulted, irritated, or intimidated. The danger here is when staff are frustrated or provoked, they may respond by engaging in a power struggle.

What is a power struggle?
A power struggle is an attempt to use threats or force (i.e., coercion) in response to challenging behavior. This can happen when you are beginning to place demands on an individual, when an individual is starting to escalate, even when an individual is in crisis! If you have ever heard a staff yell loudly, “STOP THAT NOW!” or “You better do what I say, or else!” those are power struggles. When a staff engages in power struggle behavior, that can trigger dangerous behavior which puts everyone at risk and chips away at precious rapport.

Engaging in a power struggle does not promote dignity.

Examples of power struggles: (Note: these may be subtle to an onlooker, but may seem clearly aggressive and provocative to an individual)

Physical intimidation – Bullying, posturing, angry or upset facial expressions, getting uncomfortably close, or moving too quickly.
Negative tone – Loud, angry, and/or sarcastic.
Humiliating statements – Retaliation, making fun of the person.
Threatening statements – Threatening excessive, inappropriate, aggressive consequences.
Escalating criteria of success – Increasing triggering demands upon challenging behavior, nagging.
Using force – Inflicting pain, using the most restrictive strategies (e.g., using physical management without meeting criteria) before less restrictive ones, abuse, mistreatment, neglect.
Why does it happen?
We may all experience frustration in our work and private lives, that may be difficult to leave at the door before entering work, but we cannot let that impede our therapeutic relationship with the individuals we serve. An organization should work hard to create a culture of support for all levels of staff. Such a culture teaches staff how to successfully identify a power struggle and engage in alternative behavior. Additionally, a multi-tiered culture of support values management teams that encourage helpful staff resilience solutions.

What are the alternatives to power struggles?
There are many alternatives to power struggles that promote dignity. Remember, the job is to support, not control.

Alternatives to power struggles:

Q-TIP: Quit Taking It Personally, in other words, managing your own emotional reaction. An individual may be directing hurtful statements, racial/gender-based slurs towards you but it’s not about you, it’s about the circumstances that surround the individual. Awareness of our own triggers, understanding behavior, and being mindful of physical presentation can help promote dignity.
Provide Choices: Providing 2-3 acceptable choices are powerful in helping the individual de-escalate by showing them what their options are.
Pick your battles: “Pick the battles big enough to matter, not small enough to win” (Shout out to Safety-Care trainer, Karen Manuel, of Gain Learning Center for this quote). Be aware of what you are asking the individual to do and why. Is this helping them meet programmatic goals? If not, why are you asking them to do it?
Change the request you are making: Look at how you request something from an individual, is your tone polite? Age-appropriate? Is your request respectful?
Give the person more time: A lot of the individual we work with have limitations in communication. Additionally, when anyone starts to escalate, language processing becomes more difficult. Give an individual enough time to process and even a little bit more time to decide what they want to do next.Be patient.
Be helpful: There will always be difficulties everyone’s life. Can we be helpful, supportive, the wind beneath their wings?
Change staff: Maybe the current situation is too triggering, maybe the individual is mad at you specifically, maybe you haven’t established the rapport you need to make a certain request, consider changing staff. This could be a quick step in or taking a break from working with the individual. Sometimes we may have challenging days, multi-tiered cultures of support honor reasonable staff breaks.
Safety-Care Differential Reinforcement procedures: This strategy is taught as a competency in Safety-Care trainings. This is a procedure to help replace challenging behavior with more desirable behavior by reinforcing desirable behavior and withholding reinforcement from challenging behavior.
Safety-Care De-Escalation Strategies: Highly effective, fluid strategies taught as a competency in Safety-Care. These strategies replace escalation and crisis behaviors with either functional communication, calming behaviors, or creating safe, trigger-free environment for the individual to calm themselves in.
The Safety-Care curriculum goes into great detail about power struggles and how to identify and engage in the alternatives. Staff should try to avoid power struggles by using these alternative strategies. However, just reading these strategies is not enough to promote their use. That is why we teach these alternatives using competency-based training. Additionally, some of these strategies requires the support of the organization. For example, changing staff is a strategy that requires a multi-tiered culture of support within an organization, where supervisors honor staff requests to switch out or take breaks. Adopting such a culture helps organizations provide high quality care for individuals. Safety-Care training helps establish a multi-tiered culture of support within an organization by successfully teaching skills that promotes dignity.

Are you interested in promoting dignity in times of crisis? Consider signing up for Safety-Care Trainer Training today!

References: Safety-Care Manual V.6

Keywords: Avoiding power struggles, Safety-Care Training, Competency-based training, Promote dignity, communicate respect, De-Escalation, Staff behavior

Burnout-related turnover is a complex, systemic problem that is highly disruptive to organizational functioning. Preventing and managing burnout may contribute to an organization’s success and efficacy. This post discusses how to recognize and understand burnout as behavior.  

Defining Burnout

The International Classification of Diseases (ICD-11) released by the World Health Organization (WHO) defines burnout as a syndrome due to “chronic workplace stress that has not been successfully managed. Its characterized by three dimensions: 

Measurement

It may be important to measure workplace morale and satisfaction to assess the need for intervention. An organization may choose to use a survey to evaluate staff workplace satisfaction (important aspects of survey development may be found here and here). 

Some organizations may find the use of surveys practical to their organizational settings. Others may want to use surveys in conjunction with directly observable, measurable behaviors related to professional efficacy (pinpointing performance) to see burnout in the context of their organizational goals.

From Highly Effective to Burnt Out

A highly effective staff that may have once approached their work responsibilities with vigor and a keen sense of purpose, may begin to lose sight of that purpose and become increasingly focused on the negative aspects of work. This could lead to an increase in their reluctance to perform work duties or stop it all together, resulting in a decision to leave the organization. 

Meaningful Perspectives: A Circumstantial View of Behavior

As stated above, a once highly effective staff who has stopped performing workplace duties makes organizational leaders ask, “what happened?”

Let us establish a meaningful perspective: start by viewing “performing workplace duties” as behavior. Once we shift our perspective, consider the following environmental relationship: 

Behavior is determined by its consequences. 

Consequences are anything that happens after the behavior of interest. When the consequence is something the staff likes or wants, given a similar context, the behavior is more likely to occur again. This process is called reinforcement. Conversely, when reinforcement is withheld or discontinued, the behavior drops out or stops. 

It may be that the once highly effective staff is not accessing an appropriate amount of reinforcement for their previous levels of performance and therefore, their behavior naturally reduced or stopped.

The matter then becomes understanding how to introduce or reinstate reinforcers. To increase workplace performance, an organizational leader needs to understand what reinforcers they have in their back pocket already and what reinforcers are worth investing in. Keep an eye out for future posts, in which I will discuss how to create a positive workplace culture. 

Sources: 

https://www.simplypsychology.org/operant-conditioning.html

https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases

Keywords: Burnout, turnover, Workplace culture, behavior, staff resilience 

Why Do We Need Self-Care?

Whether we work as a Behavior Analyst, Counselor, Nurse, Correctional Officer, or the many other fields that require us to care for others as part of our job; we are routinely exposed to moments of stress, traumatic circumstances, or things that can place us in a vulnerable state. One way to address these job-related stressors is through the use of self-care. Self-care habits refer to the ‘‘engagement in behaviors that maintain and promote physical and emotional well-being’’ (Myers et al., 2012).

In order for us to provide the best care to the individuals we work with, we need to make sure we take care of ourselves as well. Relative to providing the best care, Vivian Elaina and colleagues (2019) states that “the health of a hospital organization is directly proportional to the health of its doctors, nurses, and administrators”. The importance of self-care and how it relates to job performance can be even more enhanced with “those working in more restrictive settings and within a 24/7 delivery system,” especially considering the higher risk of staff burn-out rates (Jolivette et al., 2019).

So where do we begin?

In order to assess and target your own self-care behavior, start by considering “factors such as sleep, exercise, use of social support, emotion regulation strategies, and mindfulness practice” (Myers et al., 2012).

What Makes a Good Self-Care Plan?

According to Coaston (2017), a good self-care plan can follow the same formula as developing a collaborative treatment plan:

Avoiding generic strategies that mainly focus on general health practices (i.e., sleep) and instead becoming aware of one’s own signals that indicate stress/burnout can help us avoid burnout and help us decide on the first step in our self-care plan (Coaston, 2017).

A plan should also use evidence-based interventions and if we want any chance at sticking to our self-care plan Vivian Elaina et al (2019) says the strategies that we select should be brief and easy to access to account for time commitment barriers that most health-care professionals face.

Elements of Self-Care:

Coaston (2017) gives examples of three categories that we focus on when creating our own self-care plan but also reminds us that the division between categories is artificial and some strategies may meet more than one category. These are just a few strategies that could help us achieve self-care of our mind, body, and spirit. We can also come up with our own activities that will help us feel less stressed at work and in our personal lives.

What’s next?

Let’s make a self-care plan! We’ve put together a template that you can fill out with all the important components of a self-care plan. You can list specific activities that will support your mind, body, and spirit (remember one activity can support multiple areas). We’ve also made space for you to list your signs and signals that let you know you are starting to feel stressed out so you can do check-ins to see if you need to up your self-care game. Last but definitely not least, don’t forget to evaluate if your self-care activities are actually making you feel better or if they are just adding more stress and pressure to your life. If one or some of your activities isn’t making the cut, go back to the drawing board and keep trying new activities until you find a nice mix that supports your self-care goals!

Resources

Coaston, S. C. (2017). Self-care through self-compassion: A balm for burnout. Professional Counselor, 7(3), 285-297.

Jolivette, K., Swoszowski, N. C., Kumm, S., Sanders, S., & Ansley, B. M. (2019). Embedding staff self-care into the MTSS framework for those working in juvenile correctional facilities. Journal of Correctional Education, 70(1), 2-19.

Myers, S., Sweeney, A., Popick, V., Wesley, K., Bordfeld, A.Fingerhut, R. (2012). Self-care practices and perceived stress levels among psychology graduate students. Training and Education in Professional Psychology, 6(1), 55–66.

Elaina, V., Hellen, O., Arceneaux, S. R., Flores, J. A., Vo, A., & Madson, M. B. (2019). A cross-sectional study of perceived stress, mindfulness, emotional self-regulation, and self-care habits in registered nurses at a tertiary care medical center. SAGE Open Nursing, 5

Keywords: Self-care, staff retention, burnout, self-management, turnover

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