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Ep. 20: A Demonstrated Positive Impact on Training
5 Plays4 years ago
On this episode Allen talks to two of the researchers who conducted a study of the effectiveness of Vistelar's training at the Milwaukee County Behavioral Health Division (MCBHD). They spent countless hours observing as the majority of MCBHD's staff received end-user training that ranged from verbal non-escalation/de-escalation to team stabilization tactics. From environmental services to physicians, participants from across the organization participated in the training and ultimately the study.
The data gathered, through surveys, focus groups, and quantitative data showed an overall positive impact on various concerns that prompted the training in the first place. The training showed some of the following benefits:
Reduced role conflict between different staff members
Improved individuals' conflict resolution skills
Increased safety or perceptions of safety while at work, reduce burnout and turnover
Recommended
Transcript
Introduction to Conflict Management Podcast
00:00:00
Speaker
Welcome to another episode of the Confidence in Conflict podcast, your destination for learning how to prevent and better manage conflict in both your professional and personal lives.
Packers News & Teaser on Aaron Rodgers
00:00:10
Speaker
Well, I'm not much of a football fan, but if you live in Wisconsin, the latest Packers news is almost impossible to ignore.
00:00:18
Speaker
This episode is being recorded in mid-May of 2021, and you might guess that the future of Aaron Rodgers is dominating the airwaves.
00:00:28
Speaker
with most everyone waiting with bated breath.
00:00:30
Speaker
So I'll be sure to mention the outcome in a future episode.
Meet the Experts: Dr. Danielle & Dr. Matt
00:00:33
Speaker
In this episode, I have the pleasure of talking with Dr. Danielle Romaine Dagenhart and Dr. Matt Ritchie, assistant professors within the University of Wisconsin system.
00:00:43
Speaker
Back in 2017, Vissler had the opportunity to provide our conflict management training to almost 800 employees at Milwaukee County Behavioral Health.
00:00:53
Speaker
with everyone in the whole facility going through one day training program and about half going through an additional two day program.
00:01:00
Speaker
Well, Milwaukee County decided to contract with the University of Wisconsin, Milwaukee, to study the impact of this training over a two year period.
00:01:10
Speaker
Well, Danielle was the co-investigator on this evaluation and Matt was the research assistant.
00:01:15
Speaker
So in our discussion with Danielle and Matt, they share the study's research methods and the results and some of their personal observations.
2017 Conflict Management Training Overview
00:01:24
Speaker
So here we go.
00:01:25
Speaker
Well, good afternoon.
00:01:37
Speaker
Matt and Danielle, it's great to have you on our podcast.
00:01:39
Speaker
So just maybe get started.
00:01:42
Speaker
Danielle, why don't you just do a quick intro of yourself and then we'll do that with Matt and then we'll talk about this study.
00:01:48
Speaker
Sure.
00:01:49
Speaker
My name is Danielle Romaine Degenhardt, and I'm an assistant professor in criminal justice and criminology at University of Wisconsin-Milwaukee.
00:01:59
Speaker
And I was a co-investigator on this evaluation of the Milwaukee County Behavioral Health Division gatekeeper training.
00:02:10
Speaker
Cool.
00:02:11
Speaker
And I wondered, co-investigator, what a great title.
00:02:13
Speaker
Go ahead, Matt.
00:02:15
Speaker
Hi, my name is Matt Ritchie.
00:02:16
Speaker
I'm an assistant professor at the Department of Criminal Justice at the University of Wisconsin-Oshkosh, and I serve as a research assistant throughout the project.
00:02:25
Speaker
Yeah, and just quickly let the audience know about how University of Wisconsin works, right?
00:02:31
Speaker
So you're from two different University of Wisconsin schools, but how many are there in the state?
00:02:37
Speaker
Like a lot.
00:02:38
Speaker
That's a good question.
00:02:39
Speaker
And or something, right?
00:02:41
Speaker
Yeah.
00:02:41
Speaker
Yeah, I was actually at the University of Wisconsin-Milwaukee when we did this study while I was finishing up my graduate school.
00:02:50
Speaker
I don't know if you guys knew that.
Origins of the Conflict Resolution Study
00:02:52
Speaker
I taught, not criminal justice, not without a PhD, but I taught at Whitewater for three years.
00:03:01
Speaker
I think this whole professor thing is so cool.
00:03:03
Speaker
I'm very proud of you guys to be doing this.
00:03:06
Speaker
Okay, so we did this study.
00:03:08
Speaker
This goes back to 2017.
00:03:11
Speaker
And do you remember how we got started in this and what kicked this off?
00:03:17
Speaker
It was Tina, right?
00:03:19
Speaker
Go ahead.
00:03:20
Speaker
Yeah.
00:03:21
Speaker
Yeah, it was Tina was approached by someone from Vistalar.
00:03:26
Speaker
I think it was Bill Singleton.
00:03:28
Speaker
Yeah.
00:03:30
Speaker
planning on partnering with Milwaukee County BHD to do this new training on conflict resolution, non-escalation and de-escalation.
00:03:40
Speaker
And they wanted to find an outside evaluator to see whether or not the program actually works at meeting its goals.
00:03:49
Speaker
Yeah.
00:03:50
Speaker
So effectively, it'll be Milwaukee County Behavioral Health Division, which is our local county-based behavioral health facility, contracted with
00:04:00
Speaker
Milwaukee, or University of Wisconsin, Milwaukee to do this study?
00:04:04
Speaker
Yes.
00:04:06
Speaker
And both were you involved from the beginning?
00:04:09
Speaker
I was involved from relatively the beginning.
00:04:13
Speaker
I was not privy to the initial conversations, but once it seemed like this was something that could be funded and could be a good evaluation, Tina Freiburger approached me for some assistance on working on the project.
00:04:29
Speaker
And then, Matt, you got involved when?
00:04:31
Speaker
Yeah, I think I came on.
00:04:32
Speaker
I knew about the project just in conversations.
00:04:36
Speaker
But I think I came in and we started evaluating the process of it and sort of shadowing trainings and seeing what the training looked like and how it worked and sort of as a fidelity evaluation there.
00:04:51
Speaker
Yeah.
00:04:53
Speaker
So you remember the original goals, Danielle, when it first came up?
00:04:58
Speaker
Yeah.
00:05:00
Speaker
Yeah.
00:05:00
Speaker
Well, they had quite a few goals that they wanted to accomplish, specifically Milwaukee County PhD.
00:05:06
Speaker
So they really wanted to reduce role conflict between different staff members, as well as improve individuals' conflict resolution skills.
00:05:16
Speaker
They wanted to increase safety or perceptions of safety while at work, reduce burnout and turnover, which I think is something that's pretty common in organizations that provide behavioral health and mental health services.
00:05:31
Speaker
And they also wanted to increase individuals' perceptions of patients, particularly those that work with patients almost like in a direct care format.
00:05:42
Speaker
So if they work on the unit with patients.
Focus on Departmental Conflict: Lateral Violence & Role Conflicts
00:05:46
Speaker
So do you remember, we've talked about this a lot, is that the difference when we talk about conflict and we're within an organization and you're in a mental health hospital, obviously you would imagine that most of the conflict is with patients.
00:06:00
Speaker
But the first thing you talked about was conflict within the departments, right?
00:06:04
Speaker
Is that kind of between each other?
00:06:06
Speaker
Right.
00:06:07
Speaker
Conflict between each other.
00:06:08
Speaker
And this could be things like security officers and nurses having conflict about what to do if there's a crisis with a patient.
00:06:19
Speaker
whether it's who should take the lead on ensuring safety of the patient, restraining a patient, things like that.
00:06:28
Speaker
And it can even include just general conflict between coworkers, like rolling your eyes or making a sarcastic remark.
00:06:38
Speaker
Yeah, the term I just, I should probably, this has probably been around for a long time, you guys know, but lateral violence, is that?
Study Methods and Staff Feedback
00:06:45
Speaker
That's a term I've only been introduced to here in the last year or two.
00:06:48
Speaker
Is that a term that's been around for a long time?
00:06:51
Speaker
I think it's been around for at least about 20 years now from the first kind of study that I think published a scale on the concept.
00:07:02
Speaker
Yeah.
00:07:03
Speaker
In terms of people knowing that terminology.
00:07:07
Speaker
So usually it's lateral violence or horizontal violence, which is just basically lateral meaning individuals having conflict with each other within an organization rather than with the customer or the patient or the student or whatever.
00:07:22
Speaker
Right.
00:07:22
Speaker
Yeah.
00:07:23
Speaker
Yep.
00:07:23
Speaker
Conflict between people that work together.
00:07:28
Speaker
And when you think back with,
00:07:30
Speaker
was it kind of an equal thing between the dealing with the patients or was it, um, and, and this lateral violence or was it more focused on one versus the other?
00:07:40
Speaker
You remember?
00:07:42
Speaker
Um, I think it was relatively even in terms of the goals that they had.
00:07:46
Speaker
Uh, they were really concerned about role conflict, uh, particularly that staff really didn't know, you know, whose position it was to make decisions in crises, uh,
00:07:59
Speaker
being asked to do one thing, but policies and procedures might tell you to do something else and really knowing what their job is in a situation, but really also making sure that staff have better perceptions of patients and have empathy.
00:08:15
Speaker
So I think it's definitely a dual emphasis.
00:08:19
Speaker
And it was the,
00:08:24
Speaker
The methods, right?
00:08:25
Speaker
This got to be a pretty comprehensive study.
00:08:27
Speaker
This wasn't just like a little survey thing.
00:08:29
Speaker
You guys were, I mean, there was a whole bunch of elements and you stayed with the group for what, a couple of years.
00:08:34
Speaker
Yeah, we actually did a longer follow-up than what I think you typically see.
00:08:40
Speaker
So we did a baseline survey before individuals got training and then we followed them up one month after the training, one year after the training and two years after the training.
00:08:51
Speaker
to see whether or not people's perceptions change long-term or was it more of a short-term change?
00:08:58
Speaker
Very cool.
00:08:59
Speaker
And
Training Structure: Verbal and Physical Skills
00:09:00
Speaker
was it just surveys or did you do interviews and focus groups?
00:09:02
Speaker
How'd you collect the data from them?
00:09:06
Speaker
Yeah, we did mainly surveys, but we also did some focus groups that Matt led with two different groups of staff.
00:09:13
Speaker
We did one that was direct care individuals, so nurses, nursing assistants, and then one that was non-direct care staff.
00:09:22
Speaker
So I think most of them were working in a community engagement kind of capacity.
00:09:30
Speaker
And Matt, my experience has been that the...
00:09:34
Speaker
that those, it's those, that human interaction survey stuff, you learn more than what you can get out of a written survey often.
00:09:42
Speaker
Yeah.
00:09:43
Speaker
I mean, I think that's initially why I volunteered to do the focus groups because I think staff are usually pretty vocal.
00:09:51
Speaker
Yeah.
00:09:52
Speaker
When you ask them the right question, and I thought that this was a group of people that seemed frustrated.
00:09:59
Speaker
They seemed anxious about what they could and couldn't do in their own work.
00:10:04
Speaker
So when I asked them how they felt about the training, I think a lot of it was a relief, like that they were, there was less of this like mental handcuff on what they could do.
00:10:16
Speaker
And a lot of them, I thought after not only the verbal and the physical training, but there was this sense of empowerment that they understood what they were supposed to do in different scenarios.
00:10:28
Speaker
And I think through that, there was sort of, there was more collaboration,
00:10:32
Speaker
which I think would have led to a reduction in lateral violence because there weren't, you know, you weren't worried about someone not covering you because they'd all been trained the same way.
00:10:41
Speaker
And it was more of a team mentality.
00:10:43
Speaker
I think at least certainly with a direct care staff, I thought that they really bonded over this sense of, we know what we can do.
00:10:53
Speaker
We know what we shouldn't do.
00:10:55
Speaker
And now we can be more effective and keep ourselves safe.
00:10:58
Speaker
I think that's, and it,
00:11:00
Speaker
One of the stories I remember hearing was a staff member had been assaulted at work, and it was clear that nothing had been done to prevent that from other coworkers.
00:11:11
Speaker
I think after the training, it was like, we know what we have to do when we see that starting so we can bring them down earlier.
00:11:17
Speaker
Yeah, I think the... And you did those interviews when?
00:11:22
Speaker
Was that right after the training or something?
00:11:25
Speaker
It would have been a couple of months after the training.
00:11:27
Speaker
They had time to synthesize the material and get comfortable in that space.
00:11:34
Speaker
I was impressed that the training had ended and then we'd had not train the trainer episodes, but they'd decided to work on these things themselves.
00:11:43
Speaker
They had the manual still and they could check in with one another on whether it be Universal Greeting or Proximix is sort of
00:11:51
Speaker
reassess and sort of reteach each other these skills over time, which I think is something that is rare because we've all taken trainings at work or whatever.
00:12:01
Speaker
And, you know, a lot of that times, a lot of times the information goes in one ear and out the other, and you're just trying to get the training done.
00:12:08
Speaker
It seems like this one had certainly more staying power with the staff.
Impact on Staff Confidence and Skills
00:12:12
Speaker
That's one of the things that, yeah, it's, you know, the one and done training of just going in and doing a class and everybody leaves and they go, yeah, whatever.
00:12:20
Speaker
But in this case, I think they're, I remember the name, we called them champions of people that were quite interested in it.
00:12:27
Speaker
And then I think some of those people got some additional training and then they went back to their staff over time and, and continued to reinforce the, the, the main points and right.
00:12:36
Speaker
It wasn't a formal training thing.
00:12:37
Speaker
It was more of a influence and just championing being a, an advocate for it within the, or within a department or a floor.
00:12:46
Speaker
Right.
00:12:46
Speaker
Is that, do I have that right?
00:12:48
Speaker
Yeah.
00:12:49
Speaker
And they also attended the newer trainings for any new hires and anyone that had already.
00:12:56
Speaker
Yep.
00:12:56
Speaker
So they were able to sit at some of the different tables and kind of help teach and coach people that are fresh.
00:13:05
Speaker
Well, I know this was a huge opportunity for this, because it's where we have the opportunity to touch every single person in the organization.
00:13:12
Speaker
So, and I'll just do a quick summary.
00:13:14
Speaker
You guys can elaborate, but if my rem,
00:13:17
Speaker
What I remember was we actually went in and trained everybody with the one day program initially, right?
00:13:23
Speaker
That was all the frontline staff, gatekeepers, direct staff, whatever.
00:13:29
Speaker
And then we went back and trained just the direct care staff with another two days of training.
00:13:35
Speaker
Is that right?
00:13:37
Speaker
Correct.
00:13:37
Speaker
I think there was a few people that it took a little bit longer for their scheduling to get trained, but everyone was trained on the gatekeeper training.
00:13:45
Speaker
And then-
00:13:46
Speaker
that more intensive training that Matt was talking about, direct care staff got over a two-day period.
00:13:53
Speaker
And the first day was largely verbal skills.
00:13:57
Speaker
And then the second two days were mostly physical skills.
00:14:02
Speaker
Is that the way it was structured?
00:14:05
Speaker
Yeah, I think the first day is mostly sort of that verbal communicative skills.
00:14:12
Speaker
And then...
00:14:13
Speaker
For the direct care staff, there are unfortunately instances where physical tactics are necessary.
00:14:20
Speaker
And I think that was a real source of anxiety for the staff initially because the report about the restraints had come out and there were new rules about that and how you had to handle patients like that.
00:14:34
Speaker
And I think that the staff were frankly nervous about what they could and couldn't do to restrain someone who's having a problem.
00:14:43
Speaker
And I think having the trainers sort of go in and say, this is how we've trained you.
00:14:49
Speaker
So this is what's acceptable.
00:14:51
Speaker
Hold, it sort of removes the liability from you personally.
00:14:55
Speaker
And I think, I mean, you could hear like relief in the room at these times.
00:15:01
Speaker
There's people like, okay, now we, like we know.
00:15:04
Speaker
And I think they would practice that later because it is a lot of its body mechanics.
00:15:08
Speaker
So you're not, I think that's what makes it, um,
00:15:12
Speaker
a safe strategy is that you don't have to be a linebacker to do a lot of these things.
00:15:17
Speaker
It's mostly body mechanics and weight distribution, and it allows you to keep you safer, and it's an approved tactic by your employer, so you can't be held liable for it.
00:15:28
Speaker
I think that was, for the direct care staff who are seeing these things much more often than the non-direct care staff,
00:15:35
Speaker
that made everybody feel less anxious and more comfortable in their sort of direct care units because it does happen that you need to go hands-on with someone and being mindful of how that situation's playing out where you're at.
00:15:50
Speaker
I think the staff just felt so much better about that.
00:15:53
Speaker
And with all of the training combined, it seemed like they felt better equipped to do their jobs.
00:15:59
Speaker
I don't know if you guys were there with the, I just remember one story that where there was a, I think,
00:16:05
Speaker
very small woman, maybe 5'2", or whatever, and there was a, the patient, or the, that was, you know, it was all mocked up, but was like a 250 or 300 pound man, and they were able to hold the guy down using our tactics.
00:16:21
Speaker
Were you part of that one, where the 5'2", just based on what you described, Matt, very feeling a sense of empowerment of, wow, we can actually do this.
00:16:31
Speaker
I don't know that I remember that exact instance, but I do remember a, a woman of a similar size holding down someone very large.
00:16:40
Speaker
Um, and I think that that's, you know, I think, and this is the body mechanics, right?
00:16:46
Speaker
Like how can you use your weight and their weight against them to sort of quell the situation?
00:16:51
Speaker
I think a lot of what we, a lot of the two day, because it is longer because the tactics do require some body mechanics and sort of memory.
00:17:00
Speaker
Um,
00:17:02
Speaker
I think a lot of it we don't talk enough about is the verbal stuff and just like how critical, you know, we can all say that, you know, verbal is our first line of defense.
00:17:12
Speaker
But I think that training taught them that it's the first through the 10th, that like we're going to use this as long as we have to.
00:17:18
Speaker
And it's not about meeting someone's level.
00:17:21
Speaker
It's about bringing them down to a more calm and cool level because then we can get more done and we don't have to be physical.
Applying Training Skills in Personal Life
00:17:29
Speaker
But I do think the physical tactics were something that smaller staff were, it felt better.
00:17:36
Speaker
And they felt more comfortable in that space because they weren't, you know, it wasn't this, they could do it by themselves.
00:17:43
Speaker
And I think that was a big piece for them.
00:17:45
Speaker
Yeah.
00:17:46
Speaker
So we were joking before we got on the recording here, but the two of you have probably...
00:17:54
Speaker
in the world of conflict management training, have probably sat through more of our training than anybody else on the planet, right?
00:18:00
Speaker
Because you, as part of the study, you were actually in class for how many sessions?
00:18:05
Speaker
Like a lot, right?
00:18:09
Speaker
Yeah, I think it was about 20 sessions between the two of us.
00:18:13
Speaker
Yeah.
00:18:14
Speaker
I don't want to teach it.
00:18:15
Speaker
I'll let Gary and the rest of the team do that, but I definitely...
00:18:19
Speaker
it's there.
00:18:19
Speaker
Yeah.
00:18:20
Speaker
And you, you both just, just quickly without going through, I mean, there's, there's a lot of, uh, as everybody knows, it's been listening to this podcast, you know, we address the entire spectrum of human conflict now, which is what you're describing, right?
00:18:32
Speaker
All the way from the verbal stuff to crisis and the physical things and whatever, but just quickly, what would be a couple of things you remember from whatever that was four years ago that maybe you use in your personal life?
00:18:46
Speaker
Matt, you can go first.
00:18:46
Speaker
I think, uh,
00:18:48
Speaker
I think proxemics was always something I kept with.
00:18:53
Speaker
I still have the card in my wallet because it was a way to sort of manage space, I think.
00:18:59
Speaker
And of course, like pre-pandemic, I don't think I was always sort of mindful of that 10-5-2 rule, right?
00:19:05
Speaker
And I think not that I'm ever in any real danger in the classroom, but at least I am able to sort of manage that space more effectively.
00:19:16
Speaker
in case something like that, God forbid, would ever happen, that I know at 10 feet I'm cool, I know what to do, at 5 I'm a little closer, a little more ramped up, and at 2, we either get to start talking or find a different
Study Results and Training Effectiveness
00:19:29
Speaker
solution.
00:19:29
Speaker
But the proxemics, I think, just because it was so simple, and it was something that didn't take an extensive amount of training, and it just seemed so effective because staff knew that they didn't have to
00:19:41
Speaker
walk up to someone if they're getting aggressive, they can keep their space and sort of allow that conflict to resolve itself in some instances without escalating individuals.
00:19:51
Speaker
Because it is, I think the beauty of it is that it's non-escalation, not de-escalation.
00:19:57
Speaker
Let's start at nothing rather than bringing them back down.
00:20:01
Speaker
So Matt, I mean, this goes back a few years, but we did a lot of work with a group of shoplifters, the shoplifter, the loss prevention people that are in retail stores.
00:20:11
Speaker
who have to deal with shoplifters.
00:20:13
Speaker
And when we, at the beginning of the class, we said, okay, well, you know, walk up and show us how you approach somebody that's shoplifting.
00:20:19
Speaker
And they literally, I mean, these were people that had been doing this for five, 10 years.
00:20:23
Speaker
It was their career.
00:20:24
Speaker
And they literally would walk up with their hands in their pocket and get within two feet of the shoplifter and say, oh, sir, you know, do you have something in your pocket that you shouldn't have?
00:20:34
Speaker
Wait a minute here.
00:20:34
Speaker
Are you serious?
00:20:36
Speaker
And it, we just,
00:20:37
Speaker
It was like this wow moment of saying, no, why don't you step back five feet, get your hands up, and just be aware that something could happen here rather than just assume nothing's going to happen.
00:20:50
Speaker
No, I do.
00:20:51
Speaker
I think that's what people don't always think about.
00:20:56
Speaker
I think there is always space if the person isn't already elevated to sort of talk through whatever issue we have.
00:21:03
Speaker
in the study I published last year, it looks at like how jail staff manage conflict in the jail.
00:21:09
Speaker
And it's, I mean, you're, it's just so much easier to use verbal than physical.
00:21:15
Speaker
Right.
00:21:15
Speaker
But I think like being mindful of space is so critical to even like, you know, avoiding interpersonal conflict, avoiding,
00:21:24
Speaker
your own risk to safety.
00:21:26
Speaker
I think that's really where the 10-5-2 rule is something.
00:21:30
Speaker
It's like, unfortunately, always in my head because of the days of Vistolar training I have at this point.
00:21:35
Speaker
But I do- Well, the way that's part of that, Matt, is making the other person feel comfortable, right?
00:21:40
Speaker
You need to stay safe, but you get too close and the other person, you know, might be fine, but all of a sudden you're two feet from them and they're going, wow, they're getting ramped up.
00:21:49
Speaker
Right?
00:21:51
Speaker
So Daniel, what would you remember from four years ago?
00:21:55
Speaker
Yeah, I would say the showtime mindset and redirect have really stuck with me.
00:22:01
Speaker
I think, you know, sometimes there's very stressful days and I think back to the showtime mindset and having to go from one stressful situation into something else, having that take a pause, re-kind of grouping yourself, stepping on stage at showtime has helped.
00:22:20
Speaker
And I'm currently dealing with a soon-to-be one-year-old.
00:22:23
Speaker
So the redirect is very helpful to avoid tantrums.
00:22:29
Speaker
Big time.
00:22:30
Speaker
Yep.
00:22:30
Speaker
I used it with our kids all the time.
00:22:33
Speaker
Yeah, it's very, very powerful.
00:22:35
Speaker
And I think you guys know, I mean, in the early years, we still do some of this, but we did a lot of anti-bullying training.
00:22:41
Speaker
And that was the primary skill we taught to kids in grade school and middle school was the redirect, right?
00:22:47
Speaker
of how do you deal with somebody who's abusing you and billing you and whatever.
00:22:51
Speaker
And, you know, we won't teach it here, but very, very powerful technique on how to just get out of that situation and still being respectful and letting the other person save face, but not have to deal with getting verbally abused.
00:23:08
Speaker
Although your one-year-old's not verbally abusing you quite yet.
00:23:12
Speaker
Yeah.
00:23:13
Speaker
No, but it definitely saves from when something might escalate from a little upset to a full-on meltdown.
00:23:21
Speaker
So it has its users.
00:23:24
Speaker
So the results, right?
00:23:25
Speaker
There were some short-term results and then a year and then two years.
00:23:28
Speaker
And you had both quantitative stuff, actual real number kind of stuff.
00:23:33
Speaker
And then there was qualitative.
00:23:35
Speaker
There was a personal interview.
00:23:36
Speaker
So yeah.
00:23:37
Speaker
Just, you know, everybody that's listening to this is going to have a chance to get the actual study, so they'll be able to download it.
00:23:43
Speaker
But
Unified Training System and Communication Benefits
00:23:44
Speaker
what do you remember as kind of some of the highlights from the results?
00:23:49
Speaker
Yeah.
00:23:50
Speaker
One of the things that I think is really positive about the training is that people, even up to two years after, had better perceptions of how to keep themselves and others safe whenever things
00:24:07
Speaker
could potentially increase in conflict and aggression.
00:24:14
Speaker
And another thing that kind of I think is important to the training is that direct care employees really felt more confident in working with patients and they felt like there were less constraints
00:24:28
Speaker
from behavioral health division on providing appropriate care.
00:24:32
Speaker
And I think that kind of goes back to what Matt was talking about, where they felt like they now have the tools, the tools from the training reflect the policies, so they don't necessarily feel like their hands are tied if they have to engage with the patient physically to kind of escalate the situation.
00:24:49
Speaker
You know, this confidence thing comes up all the time with us.
00:24:52
Speaker
You know, we always think, well, it's going to
00:24:54
Speaker
you know, reduce injuries, you know, they're going to, there's going to be less conflict.
00:24:58
Speaker
There's going to be, you know, less workman's comp claims.
00:25:01
Speaker
There's going to be better morale, whatever.
00:25:03
Speaker
But when we do our own surveys, it's, it's just that word confidence comes up a lot.
00:25:10
Speaker
It's just feeling more confident to be in a situation where conflict might occur and knowing that you know what to do and, you know, and you're probably doing the right thing and you're not going to get in trouble for it.
00:25:21
Speaker
Right.
00:25:22
Speaker
And I don't know if you guys know, but it's early on when we had to choose a title for the books we published.
00:25:29
Speaker
And we selected Confidence in Conflict as the headline title for all our books.
00:25:36
Speaker
But Matt, what do you remember from?
00:25:39
Speaker
I mean, I think going back to what Danielle was saying, I think there's just so much less ambiguity.
00:25:45
Speaker
I think that's what people don't get frustrated and nervous when they know the game.
00:25:50
Speaker
They understand what A and B is and they're not worried about it.
00:25:53
Speaker
I think being specific about what's expected and what you can and can't do, I think brings down that ambiguity.
00:26:01
Speaker
It makes people feel more comfortable, which is why I'm not, I mean, we did the focus groups shortly after the training and so it was still relatively fresh.
00:26:10
Speaker
But to see it two years later that it hasn't shifted isn't surprising.
00:26:14
Speaker
I think there's less ambiguity.
00:26:16
Speaker
They understand and it's all uniform.
00:26:19
Speaker
everybody got the same training and everyone knows the same tactics and they can all sort of speak the same language, right?
00:26:25
Speaker
I think that approach almost has to be the approach you take when you're dealing with any agency is that everyone has to be aware of all the same tactics, all the same communication to make this be effective.
00:26:41
Speaker
And I think BHD, I applaud them for really taking the deep dive here and
00:26:48
Speaker
implementing this program agency-wide so that everyone is on the same page.
00:26:52
Speaker
I think putting new hires through a day to almost additional two-day training is no small ask.
00:27:00
Speaker
But I think their commitment to this new approach and sort of a non-escalation approach and keeping things uniform is something that I think can only help BHD and agencies that adopt this down the line.
00:27:14
Speaker
I think that's really, the ambiguity is always, that was always what was most frustrating.
00:27:20
Speaker
And the empowerment they got from the training.
00:27:23
Speaker
I mean, you could just see it in their eyes and hear it in their voices when the training was over.
00:27:26
Speaker
They were like, I finally, I don't feel like I'm trapped and I don't feel in danger anymore.
00:27:31
Speaker
I feel like I can do my job effectively now.
00:27:34
Speaker
And now just for the audience, you say it's a term non-escalation a few times here.
00:27:40
Speaker
I think everybody probably understands what that means, but that's
00:27:43
Speaker
That's our terminology for preventing conflict, right?
00:27:46
Speaker
Doing all the stuff that you can do to keep things from ever escalating rather than only thinking about de-escalation and crisis management and what do I do if I get hurt or hit.
00:27:58
Speaker
The focus is let's prevent this so you never have to deal with it.
00:28:02
Speaker
But with the awareness that you still might have to deal with it and then having the confidence that you know what to do if it ever happens.
00:28:11
Speaker
So,
00:28:13
Speaker
I just remember a lot of, when I read the study, a lot of what I thought were kind of crazy numbers in terms of percentages, where 93% thought this, and 97% thought it was useful, and 91% said they continued to use the tactics.
00:28:28
Speaker
Is that normal, or was that kind of a surprise?
00:28:36
Speaker
That was a surprise to me, in particular that after two years of
00:28:41
Speaker
experiencing the training that there was a pretty sizable proportion of people that still utilize the training and the vast majority of the people that utilized it really did find that it was effective most of the time at either keeping something from escalating or deescalating something that might have already started to blossom as a conflict.
00:29:04
Speaker
Yeah.
00:29:05
Speaker
It's, it's, you know, Matt, your, your point about having a unified system that everybody
00:29:12
Speaker
is bought into and they're all getting the same training.
00:29:14
Speaker
The terminology I think is a big part of that, right?
00:29:17
Speaker
Just knowing what to call things.
00:29:19
Speaker
Like Danielle, you talked about showtime mindset.
Non-Escalation Strategies in Various Sectors
00:29:23
Speaker
You know, we see that all the time.
00:29:24
Speaker
If everybody knows what showtime mindset is, and again, we're not gonna teach it here, but it's basically a mindset of saying, you know, step back, take a deep breath, get your facial expression right.
00:29:36
Speaker
You know, it's showtime.
00:29:37
Speaker
It's time you're stepping on the stage, right?
00:29:40
Speaker
This is a performance.
00:29:42
Speaker
And, you know, we've seen it in emergency departments where it's literally somebody is maybe just getting a little bit, you know, escalated and it's just somebody else can just look at them and say, hey, showtime.
00:29:55
Speaker
And they go, oh yeah, yeah.
00:29:57
Speaker
They get it immediately and it's just one word and it can change the whole nature of an interaction.
00:30:05
Speaker
Your one-year-old will remember the, remember showtime.
00:30:09
Speaker
Yeah.
00:30:11
Speaker
He'll also remember that I rarely use the word now.
00:30:14
Speaker
Yeah.
00:30:16
Speaker
When there are three and it's you, Danielle, that need to... Yeah.
00:30:21
Speaker
Yeah.
00:30:23
Speaker
Then I'll be told showtime.
00:30:26
Speaker
Hey, Mom, showtime.
00:30:29
Speaker
So, okay.
00:30:32
Speaker
So, what did I miss here?
00:30:34
Speaker
What else should we be talking about relative to the study?
00:30:37
Speaker
And obviously, you guys...
00:30:40
Speaker
you do research, right?
00:30:42
Speaker
This is just one of many studies.
00:30:43
Speaker
Is there anything else that makes this unique or stands out or whatever?
00:30:52
Speaker
Yeah, I think there are a lot of conflict training programs out there and there is a decent amount of research on a lot of these programs, but the sheer kind of number of goals that they wanted to accomplish and how many of those
00:31:10
Speaker
actually were met, not just about increasing confidence in skills, but, you know, decreasing burnout, decreasing turnover.
00:31:19
Speaker
I think that really speaks to the power of this training to go beyond just competence, but really affecting kind of the culture of the workplace and how people interact, like the horizontal violence and having less role conflict.
00:31:35
Speaker
Yeah, I remember that, that that was
00:31:37
Speaker
When we got started, culture was a big word used that we need to modify and prove.
00:31:43
Speaker
I can't remember what the goal was, but culture of just how people interact and kind of the whole fabric of how the place operates.
00:31:51
Speaker
And I think we accomplished some of that, right?
00:31:53
Speaker
I mean, that's a big goal.
00:31:55
Speaker
Change of culture.
00:31:59
Speaker
I think they have seven, 800 employees.
00:32:02
Speaker
It's that kind of number.
00:32:03
Speaker
So
00:32:05
Speaker
it's not, this is not a group of five people you're changing a culture for.
00:32:08
Speaker
It's a, it's a big organization.
00:32:10
Speaker
Yeah.
00:32:11
Speaker
I thought that was a, I thought that was a key piece because people, it's reduced ambiguity, increased empowerment, and you sort of saw them ushering new staff in the same way.
00:32:22
Speaker
It was like, oh, like, this is how we do this is what this means.
00:32:25
Speaker
And I think their initiative to really take their training and,
00:32:30
Speaker
embedded in their workplaces and their units and then usher and sort of acclimate new staff to this was a big, it tells me that this is effective if only to make staff feel safer and feel more confident in their roles.
00:32:47
Speaker
And it's staying power.
00:32:48
Speaker
I think that can't be understated that so much of this is still around four years later.
00:32:57
Speaker
Yeah.
00:32:58
Speaker
Danielle, do you have another point?
00:32:59
Speaker
I was going to make just one thing I heard recently about being able to help, but go ahead.
00:33:03
Speaker
Oh yeah, no, I was going to say it's kind of hard to measure culture quantitatively, but I think the focus group information that Matt got really attests to a lot of staff feeling like the culture really has shifted towards, you know, more understanding between all staff, even people not on the same unit feeling comfortable that someone else coming in
00:33:27
Speaker
if they're just walking through the unit or subbing, that they all have each other's back and know what to do if something happens.
00:33:35
Speaker
Yeah.
00:33:36
Speaker
Well, I just shared a comment I heard a couple of months ago from a children's hospital, actually.
00:33:43
Speaker
And, you know, this is a behavioral health hospital, so mental health patients.
00:33:48
Speaker
And it's a children's hospital, right, that deals with kids.
00:33:51
Speaker
And you think, you know, friendly place and whatever.
00:33:54
Speaker
But she said the whole, in her opinion,
00:33:58
Speaker
higher healthcare environment now is, is shifting towards a behavioral health environment that there's just so much mental health, mental illness and, and issues with anxiety and whatever that all the principles that apply to that, that would, you know, be really, really crazy important within a mental health hospital or behavioral health hospital are now applying to pretty much any healthcare institution.
00:34:25
Speaker
So I, and, and,
00:34:26
Speaker
And Matt, with your experience in criminal justice and corrections, it's the same issue.
00:34:31
Speaker
As Gary says, corrections, they're kind of the de facto mental health hospital now.
00:34:37
Speaker
Yeah, well, I think it was good to see when we did the study a couple of years ago, a different study, it's sort of the recognition that we don't have to fight everybody all the time.
00:34:48
Speaker
I mean, when we don't hear about anything,
00:34:52
Speaker
it's usually good news, but we don't hear about it, so we don't find out about it.
00:34:56
Speaker
But I think this shift towards interpersonal skills being the first line of defense and then just keeping at that until we've exhausted it is where certainly corrections and law enforcement is heading at this point.
00:35:12
Speaker
Because it's too much physical work to be going hands-on every time.
00:35:17
Speaker
And it's an immense amount of paperwork.
00:35:20
Speaker
And I really think that
00:35:22
Speaker
you know, if we're going to be equitable in our treatment of the individuals we serve, that we have to be more attuned to our interpersonal skills and less resorting to physical skills because it just use of force never photographs well.
00:35:39
Speaker
That's a hat tip to Steve Brandon who says that all the time.
00:35:43
Speaker
But I think that there is a demand sort of from our communities to use more verbal skills
00:35:50
Speaker
initiatives and less physical.
00:35:53
Speaker
And I think Vista Lord does that training teaches them that that's what's most important and that the physical tactics take two days because they are more involved.
00:36:02
Speaker
But if you can talk someone out of being violent, you're far better off than if you have to fight with them to let them not be violent.
00:36:12
Speaker
I love your comment about paperwork.
00:36:13
Speaker
It's one of my
00:36:14
Speaker
Every time you guys are both familiar with our persuasion sequence and the second step is to give people options, right?
00:36:20
Speaker
Here's the good option.
00:36:21
Speaker
And then, oh, we got some bad options.
00:36:23
Speaker
And I just love it when, you know, police officers go, you just can't imagine the paperwork we're going to have to go through here and how long that's going to take.
00:36:30
Speaker
And you really want to do that, right?
00:36:34
Speaker
I mean, whatever it takes to deter future violence, I think if the paperwork will stop it, then I'm all for it.
00:36:40
Speaker
But it does.
00:36:41
Speaker
And I'm chatty, so I think I can talk into most things, but I think it just seems like a safer route for everybody, both the person who's in need of help and the person trying to deliver help.
00:36:53
Speaker
I think it's just an overall better route.
00:36:56
Speaker
And I hope we see more of it down
Long-Term Impact and Cultural Shifts
00:36:58
Speaker
the line.
00:36:58
Speaker
I think VISTA law really has an opportunity to promote this in different areas, behavioral health, law enforcement, corrections.
00:37:05
Speaker
I think it's a real promise there.
00:37:08
Speaker
Yeah.
00:37:09
Speaker
Well, very cool.
00:37:11
Speaker
Well, I very obviously very much appreciate you guys' time.
00:37:14
Speaker
It's been, so what was it?
00:37:17
Speaker
I think the training started in September of 2017.
00:37:20
Speaker
Does that sound right?
00:37:23
Speaker
So this is, right, two years.
00:37:26
Speaker
And then there was kind of a follow-up report, right?
00:37:29
Speaker
Wasn't there an initial report and then kind of a second where you actually got access to some of the hard data that you talked about, right?
00:37:38
Speaker
Yeah, so we first did a one-month report, which would have been in, I think, December of 2017, looking at just kind of one-month changes.
00:37:47
Speaker
And then we did the final report of the survey and the focus group data.
00:37:52
Speaker
And then we also did a supplemental report on actual files of use of restraints and use of seclusion.
00:38:02
Speaker
And that data also suggested that the training significantly reduced having to rely on those from the period before the training.
00:38:13
Speaker
Yeah, very cool.
00:38:15
Speaker
Well, appreciate your time.
00:38:17
Speaker
Thanks so much.
00:38:19
Speaker
And you'll have a chance to hear all this here once we get it all finalized and buttoned up, and we'll get you a copy of the file.
00:38:29
Speaker
Cool.
00:38:29
Speaker
So thanks.
00:38:31
Speaker
Thanks for having me.
00:38:32
Speaker
Yep.
00:38:32
Speaker
Take care.
00:38:34
Speaker
Well, that wraps up another episode of Confidence in Conflict.
00:38:38
Speaker
Hope you found that discussion valuable.
00:38:41
Speaker
If you want more expert advice on how to prevent and better manage conflict, subscribe to this podcast.
00:38:46
Speaker
at Apple Podcasts, Stitcher, or wherever you get your podcasts.
00:38:50
Speaker
And if you like this episode, please write us a review.
00:38:53
Speaker
Also visit Vistolar.com slash blog to get notes for this show, share your comments, and access additional conflict management resources.
00:39:02
Speaker
Take care and stay safe.