Developed by Ella Jackson, LMFT

Who I am

• Ella Jackson, LMFT, Clinical Supervisor for Long Term Care Team in Sonoma County, California.

• Team serves adults with severe and persistent mental health conditions.

• Conserved, living in locked psychiatric facilities.


• Team uses the ANSA to assess if clients are ready for a lower level of care and

determine their risk factors.

• Our county has an algorithm that determines the level of services a person receives based on their ANSA scoring.

• Part of my role: review ANSAs for accuracy, recommend changes if indicated, and sign off on them.

• I also do county wide trainings for adult outpatient teams on the ANSA (Became a Trainer through last year’s TCOM Conference in Seattle).

• This gives me a broad perspective: train, review and sign. Repeat.


Ever heard anything like this about the CANS or ANSA?

• “It’s so time consuming!”

• “Another form to be completed.”

• “Really I have to do this on top of everything else?”


Training Staff To Use and

The CANS/ANSA


OVERCOMING RESISTANCE WITH: 1. Humor

2. Reflective Process

3. An Individualized Approach


Let’s talk about Resistance

.


Starting with my OWN RESISTANCE


• In preparing for this presentation, I found myself dragging my feet, putting it off, feeling overwhelmed by the thought of doing this.

• My own resistance.


Had to dig deep: what was under my resistance?


• BIG feelings!

• What if I’m boring?

• What if they spend my whole presentation looking down at their phones?

• An opportunity to use my techniques for addressing staff resistance on….


http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwixqb62_vnPAhUBTWMKHRXYC8wQjRwIBw&url=http://thereseborchard.com/2013/08/27/5-things-to-do-when-you-feel-insecure/&bvm=bv.136811127,d.cGw&psig=AFQjCNHZce6OAPPVhdwGcINl5LOuPnvjng&ust=1477623432006431

What to do? • I did some research, figured out I have a

common condition. • Glossophobia: fear of public speaking. • Treating my resistance: • Humor • Reflective Process • Individualized Approach


Humor

…so what if they look at their phones the whole time I talk?


Reflective Process

The ability to reflect on an action or process so as to learn from it.


Reflect on Process • My typical process of resistance: • I don’t do the thing I am resisting (procrastinate)

• makes it worse

• mounting anxiety increased feelings of overwhelm

• = MORE RESISTANCE


• The learning for me that came out of this reflective practice: I am making myself feel bad.

• Increasing the very thing I’m trying to decrease.

• Started talking to staff and supervisors from other teams about their experiences with paperwork, projects, productivity and their resistance.


DISCOVERY…

We all experience resistance.


• What does resistance look like for you?

• What does it look like in your days at work?


An Individualized Approach • Individualized approach: the practices of teaching which

recognize the uniqueness of each student learner.

• Provides guidance and support to bring about the development of the whole person (mind, body, and spirit).


Individualized Approach: Using it on myself

I’m going to talk about my work, what is meaningful about this tool for me. How I have helped staff learn to

use the tool, and tailor it to their own style and the client’s needs.


How to make learning fun for staff?


** Credit to Robin Orlando “Steal relentlessly”

Rules: 1. Answer must be written down 2. Raise your hand once it’s been written down 3. First person to get it correct wins a prize

CANS/ANSA Jeopardy!


Name the 6 domains of the CANS.


6 Domains of CANS

• 1. Life Functioning

• 2. Child Strengths

• 3. Acculturation

• 4. Caregiver Strengths & Needs

• 5. Behavioral/Emotional Needs

• 6. Risk Behaviors


Name 5 Risk Behaviors on the ANSA.


Risk Behaviors on the ANSA:

1. Danger to Self/Others

2. Self-Injurious Behavior

3. Other Self-Harm

4. Exploitation

5. Gambling

6. Sexual Aggression

7. Criminal Behavior


Resistance:

• Refusal to accept something new or different

• The ability to prevent something from having an effect

• Any force that slows down or prevents change.


What does resistance look like in the people we supervise?


Resistant Person #1: The person who has an endless supply of excuses of why it won’t

work, why they can’t do it. “I already have too much paperwork” “My caseload is too big” “I need a mental health day” “I have a migraine again” “My basement flooded”


Resistant Person #2: The person who seems like they are implementing the

change, but is hiding the fact they are doing things the old way, in case things don’t work out.

(not really changing, just covering the bases)


Resistant Person #3:

The person who is enthusiastic and agrees the change should happen, but never quite seems to do it themselves….

Procrastinates endlessly.


Resistant Person #4:

The person who hears about the change, starts avoiding you, taking more sick time, getting to meetings late.


Our reaction


Frustration…


Despair.


We start feeling fatigued.


We start eating starchy food at our desks.


We wonder what made us ever sign up for this…


How can this translate to our work with staff?

Can make it harder than it needs to be.

We take their resistance personally.

We become defensive.

We blame the staff person for not changing.


Fundamental Attribution Error TED talk on resistance by Heather Stagl • When other people are resistant we attribute their

behavior to their character/personality. • With the person we are supervising, who we

experience being resistant, we tell ourselves: • “they are resistant to change” • “they are trying to be difficult”.


Whereas when it comes to us, we tell

ourselves there are valid reasons for our

behaviors.


What do we do as supervisors when we are met with resistance?


• We try to make those resistant behaviors stop.

• If our staff is coming up with excuses, we come up with all the counter arguments for why they are wrong.

• If someone is procrastinating , we remind, remind, remind…we nag.


The Battle

The change becomes a battle to win, not something we are collaborating on together.


What is your reaction when someone tries to make you do

something you don’t want to do?


I dig in my heels even more, pull out all of my resistant behaviors.


Do what I’m being made to do, but with growing resentment…

Do a half *&@! job.


How does this impact your relationship with your staff?

When we address resistant behaviors directly,

it only makes them stronger.


Where to start…

When you find yourself in an entrenched battle with a resistant staff person…

When high performing staff are forced to do more work because of an under performing

staff member…

When people start whispering “how many more years until she retires?”


Start with the bigger picture


Treat the source, not the symptom

When we address the resistance we are only addressing a symptom.


What is the underlying cause of the resistance?

– For one person, maybe they are not really clear about what they’re supposed to be doing, but they’re embarrassed to ask.

– For another person, they may not be comfortable with their ability to do the job well, and so they don’t even want to try.

– And then there’s us… – are WE sending signals that we don’t think they’ll do

what we ask? – Have you, the supervisor, made friends with the

CANS/ANSA? – Low supervisor buy-in = low staff buy-in


How to Approach Resistance … Effectively


Reflective Process • Important to humanize the work: Reflect on the

person giving the assessment. Does she feel pressure to complete it quickly? Anxious about not knowing the tool well?


Slow things down, See the person. Verbalize strengths.

Identify the personal barrier to using the tool.

The resistant staff person.

Allow for gradual growth. Praise. Support. Repeat.


Hold the Space

It is important for us as supervisors to be able to hold space for resistance, for anger, for frustration.


Ask hard questions (and be ready to hear answers that are triggering)

Do they feel like decisions are being made about them, without their input?

Does it feel like there is an insinuation that what they are already doing isn’t good enough?


.

Lead with vulnerability: let them know you are human, share your own struggles with learning a new tool.


When people resist change there is something going on under the surface.

When we can understand the experience of the change from their point of view, then we have something we

can address, and help them deal with.


• Encourage your staff to share their honest reactions and feelings.

• Sometimes it is as simple as active listening and reflecting back what we hear.


It can feel like a lot of time to sit with staff and explore their resistance… their feelings

underneath the push back.


• When you take the time to do this as staff need it, you are preventing fighting the same issues…

…..OVER AND OVER.

• Making an investment (in your own sanity).

• Saving yourself time in the long run.

“An ounce of prevention is worth a pound of cure.”


Overcoming Resistance with Humor

• The work we do can be heavy.

• High productivity demands.

• Piles of paperwork.

• Working with large numbers of clients with big needs in systems with limited resources.


• I joke with staff about the dark stuff. (Respectfully)

• Make laughter a priority.

• Humor is personal, important to know the culture of your team, and to build a space where people can laugh about the challenges we all face.


Individualized Approach Make the tool Personal to the assessor


What instrument do you need? A hammer? A ruler? Pliers?

Build your tool.

Help staff to see that the CANS/ANSA is a tool.


Individualized Approach Some case managers like to have the

CANS/ANSA in front of them when they meet with the client.

Use it in the session with the client as a way to engage and empower the client.


Individualized Approach

Some case managers do not like to have the paper assessment in front of them.

Feel like writing when meeting with the client is distracting and adds a cold clinical feel.


Start with where staff’s interest is. What are they passionate about?

Cultural issues? Risk factors? Support them in starting where they are naturally

the most curious about the person sitting in front of them.


Individualized Approach

“It’s just a bunch of numbers. It’s impersonal”

The clinical summary: a place to flesh out the numbers and make them more personal.


A few last ideas…


Don’ t rely soley on technology to teach your staff.

The Praed Foundation website is an excellent tool.

But, what message are you giving staff if this is the only way they are taught to use this assessment?


After all … the CANS/ANSA are interactive tools that are built on assessors having a meaningful

conversation with clients.

This starts with their supervisors having a meaningful conversation with them about this

tool.


Don’t train large groups: Keep training groups small. 4-6 people.


• When introducing the CANS/ANSA, give an overview.

• Send staff home with the domains, have them study and familiarize themselves with the tool, then come back for another training.


• Make the training something you do more than once before testing. People need time to digest the material.


• Slow down the learning process.

• By doing this you give staff the message that it is ok to slow down the assessment process, to be thoughtful in their learning and application of the CANS/ANSA.


• Help staff to understand the INTENTION of the CANS/ANSA.

• It’s not about scoring it perfectly, it’s about identifying needs and strengths.

• The Goal: 2 different case managers looking at the same client are able to identify the same treatment needs and strengths.


Have check-in meetings with staff about the tool, obstacles they are encountering, areas

where they feel uncertain about scoring.


Make getting to know the domains and line items fun.


Address resistance by uncovering what is underneath it.


Take an Individualized approach.

Help assessors make the tool personal to themselves, their own unique tool.


Be vulnerable: tell them your own experiences around test taking, learning a new tool, mistakes you made when you were new or were learning to implement

a new tool.


Don’t get rusty or forget what it’s like to be in the individual provider’s shoes.

Know your tool: supervisors should continue to do a CANS/ANSA at least once every two months to keep their skill set fresh.

Stay skilled in the work you are asking your staff to do. Developed by Ella Jackson, LMFT

• Emphasize what you do for self-care.

• Give them the meta message: you matter. This is not intended to make you suffer.

• Handout: 15 Strategies for Addressing Staff Resistance


How do you address it?

What does resistance look like in your day? With your staff?


Developed by Ella Jackson, LMFT

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