• De-Escalation Techniques
• Practice Challenge: Kai
• Performance Dashboard
• Supplemental and Material Resources
• Survey
• Certificate of Completion

De-escalation Techniques

Pic 0: The title card “Navigating Difficult Conversations” appears before transitioning to Dr. Owens.

Early in my career, I wasn’t sure how to deal with emotions that arose when I discussed unexpected changes or information clients didn't want to hear. I was intimidated, sometimes frightened, creating tension that made the visit uncomfortable.

Pic 1: The screen changes to one where Dr. Owens sits across from a blonde woman. The text “Peggy: in her 40s, liver problems” appears between them.

I can’t forget Peggy. She was in her 40s and had been with our care team for years when it became clear she had developed liver problems.

Pic 2: The text is replaced by new, blue text which reads “Alcohol Consumption.”

I asked about her alcohol consumption.

Pic 3: The screen zooms in on Peggy, and the background turns red. The text “No way it’s alcohol related!” appears. After a moment, the screen changes to Dr. Owens and Peggy again but Peggy is pointing at Dr. Owens and text appears that reads “You’re wrong!” in big red letters.

She argued there was no way it was alcohol-related, that she was too healthy, that we were wrong.

Pic 4: Dr. Owens looks down at a medical chart, and the words “Based on the screening” appear between the two women.

So, I said, just based on the screening, she needed to make some changes or she could be dealing with some pretty serious repercussions.

Pic 5: Peggy looks down and her face turns red.

Her face turned red as she held back tears. She gritted her teeth and said her father had an undiagnosed alcohol problem, that they all suffered from his drinking.

Pic 6: The screen zooms in on Peggy again, who has her arms crossed and is crying. The text “I’m nothing like my father” appears on a red background.

She told me she was nothing like him.

Pic 7: The screen returns to Peggy and Dr. Owens. Dr. Owens has her hands up defensively with a shocked expression as Peggy points at her while crying. After a moment, the words “I’ve had enough!” appear between them.

I tried to bring it back to the screening numbers, and she said she'd had enough, got up, and slammed the door so hard a picture frame smashed on the floor.

Pic 8: The screen returns to Dr. Owens, alone.

I’m Melanie Owens, and after that incident, I decided it was time to learn better techniques for telling clients things they don't want to hear.

I've trained extensively with evidence-based frameworks proven to de-escalate emotionally charged situations and work through frustrations with individuals.

Pic 9: The acronym “CAF” appears next to Dr. Owens, before expanding to read “Calm Assess Facilitate.” Below, the acronym “MI” appears, which expands to read “Motivational Interviewing.”

The two we’ll discuss today are the CAF framework and MI.

Pic 10: The text is replaced by “Safety” and “Health.”

Your overall goal for the conversation should be the safety and health of the individual. You may need to compromise on what you want from the visit to keep that at the forefront.

Pic 11: “CAF” and “MI” appear again next to Dr. Owens, replacing the previous text.

Thinking about Peggy, I wanted to share information and make a management plan. But Peggy wasn’t ready for that. She needed me to acknowledge her underlying challenges first, with CAF and MI.

In hindsight, I should have known that delivering the news could upset Peggy. I could have done more before, during, and after the visit to help her.

Let’s look at how we model the flow of a challenging visit:

Pic 12: A title card appears which reads “Strategies for Preparing for Difficult Conversations” before transitioning to a screen with three titles at the top, “Pre-Visit,” “Visit,” and “Post-Visit.” “Pre-Visit” is highlighted, and the following information is included in bullet points.

• Read chart notes and reflect on experiences with the individual.
• Write notes or draft how you will discuss the topic.
• Arrange adequate time.
• Alert the rest of the staff and strategize for client support.
• Prepare print-outs, websites, or other materials for the client.

Pic 13: Now “Visit” is highlighted, and the following information is included in bullet points.

• Use the Calm, Assess, Facilitate (CAF) model to talk about the sensitive topic.
• Use Motivational Interviewing (MI) to address emotions and de-escalate the situation.
• Pay attention to non-verbal cues.
• Acknowledge external factors and other sources of frustration to better connect on the topic at hand.

Pic 14: Now “Post-Visit” is highlighted, with the following information:

• Make a plan to follow up with the individual at another appointment to check on progress.
• Document the meeting with the client and include any relevant notes for others who may work with the individual next.

Pic 15: “Visit” becomes larger and the other categories disappear. After a moment, the screen changes to a title card which reads “De-Escalating During a Visit” before transitioning to a close-up on Dr. Owens. Text appears next to her which reads “External Factors.”

Let’s zoom in on the Visit portion.

Individuals can have emotional responses for any number of reasons, including external factors.

Here are some examples of external factors that could affect an individual's mindset:

Pic 16: The screen changes to one titled “External Factors.”

• Arguing with their partner
• Family member is sick
• Took unpaid time off work for the appointment
• Trouble finding parking
• Waited a long time to be seen

Pic 17: The screen returns to Dr. Owens.

Visual cues that indicate frustration can hint at external factors. In Peggy's case, I didn't realize she had an emotional past linked to alcohol use.

Pic 18: The screen returns to an image of Peggy pointing angrily at Dr. Owens.

What I should have noticed were the visual cues she was becoming upset and stopped pushing the subject.

Pic 19: The screen changes to one with text at the top which reads “These are examples of body language you may notice in an individual who is feeling frustrated.” Below is a blue figure outlined in black sitting on a chair who is looking downward. Text next to the figure reads “Avoiding eye contact.”

Pic 20: The top text stays the same but the figure is now fidgeting with their fingers. Text next to them reads “Fidgeting.”

Pic 21: In this slide, the figure has clenched fists with exaggeration marks around it. The text next to it reads “Clenching fists.”