John PlonskiDatabase CoordinatorCovenant House InternationalPresident NYS AIRSjplonski@covenanthouse.orgVoice: (212) 727-4040Fax: (212) 727-4964

Claim Jumpers:Working with Chronic Callers

AIRS 31st Annual I&R Training and Education Conference“Mining for I&R Excellence”

Reno, NVWednesday June 3, 2009Part 1 – 2:15 – 3:45 PM

John has been involved in crisis intervention since 1984. Beginning as an overnight volunteer crisis counselor for six years at Response of Suffolk County. Since 1989 John has worked for the Covenant House Nineline, a national crisis hotline for youth under 21 and their families. Over the years he has served Nineline as a crisis worker, shift supervisor, and is currently Nineline’s Database Coordinator. In this position he oversees the maintenance of the agency’s call entry and referral databases. At present Nineline’s referral database consists of over 30,000 records providing referrals throughout the United States and its territories.

John has presented basic and advanced crisis intervention skills development training for his own and other agencies. His presentations of various topics at training conferences on the state and national level have been well received. He has also developed skills development trainings for individual agencies. John has consulted on several of the AIRS on-line training modules as well as the AIRS/United Way “Managing the Surge: 2-1-1 Volunteer Surge Management Curriculum”. His involvement at the 2-1-1 call center in Monroe, LA following the 2005 Gulf storms lead to his becoming a member of the AIRS/United Way 2-1-1 Disaster Response Team. He has been a volunteer board member of the New York State Alliance of Information and Referral Systems (NYS AIRS) since 2000 and is currently their President.

John can be reached at jplonski@covenanthouse.org or by calling Covenant House International at (212) 727-4040.

Your presenter this afternoon

is...

And most importantly we will come to understand the true nature of the

“Problem”

Our reactions to the interaction.

• I think Chronic Callers are…

• Chronic Callers make me feel…

• I think all Chronic Callers should be…

• John is so cool because….Psst…You really don’t have to answer that one. We all know why.

First…your thoughts about Chronic Callers.

The one commonality between all telephone based I&R services is the Chronic Caller. Be they called Chronic, Repeat, Experienced, or Constant

Callers we all know who we are referring to. In today’s session we will look at:

Why Chronic Callers call How to identify Chronic Callers The frustrations Chronic Callers elicit in us Reasons for letting Chronic Callers call How to make your staff aware of who is a Chronic Caller Models for working with Chronic Callers How to interact with Chronic Callers when establishing policy How to become an effective Chronic Caller.

Today we are going to talk about...

• We tell them to

• We listen

• The "Warm and Fuzzies”

• Inconsistent Reinforcement

• We like them

• They like us

• We have to talk to everyone that calls

So why do Chronic Callers call us?

We can define Chronic Callers as those Callers who:

• Call frequently over an extended period of time

• Are consistent from call to call

• Have the same presentation call to call

• Are unwilling or unable to effect change

• Are aware of the mechanics of the I&R process

• Initiate contact out of habit

• Have a story that seems rehearsed

So who is a Chronic Caller?How do we determine who they

are?

We can define Chronic Callers as those Callers who:

• Call frequently over an extended period of time

• Are consistent from call to call

• Have the same presentation call to call

• Are unwilling or unable to effect change

• Are aware of the mechanics of the I&R process

• Initiate contact out of habit

• Have a story that seems rehearsed

So who is a Chronic Caller?How do we determine who they

are?

Yes, they are frustrating because:

• They make you feel trapped

• They make you feel like a failure

• Chronic Callers are “crazy”

• They are resourceful

• “Why don’t they do something…anything?”

• They are different

• They make us frustrated and angry

• “I can change this Chronic Caller!”

But they are so frustrating! They make me angry!

How about reasons for not

letting Chronic Callers call? • They are potentially frustrating to and demanding of the staff

• They use up valuable resources

• Their contacts may be preventing them from getting the help they need

• Their contacts may be “splitting” their therapy

• Modeling of inappropriate behavior

• The record of their contacts can provide an inaccurate view of services provided

It’s not quite that easy because:

• We invite them to call us

• They can call us

• Sometimes even Chronic Callers need help

• It makes it easier to work with them

So why do we let them call?!Why should we let them call?!

I say just refuse to take their calls and it’s a done deal!!!

However, there is an exceptionto the rule.

In the case of a Chronic Caller who is threatening or abusive it would be reasonable to adopt a no contact/no engagement policy. But keep in mind this does not mean they will not contact you again.

First of all we need a method to positively identify them that mitigates the possibility of misidentification.

An effective system would include:

• Basic Information about the Caller

• A more in depth Identification Profile

• The Background and History of the Caller’s contacts

So how do we go about working with Chronic

Callers?

Set limits!

Do not be afraid to develop and enforce policy Accept that while Chronic Callers ask for help, they are either unwilling or unable to use that help

Consider the likely outcome of your decision to talk with this consumer

Consistent interaction

Work together within the agency

Maintain professionalism and respect

Some rules for working with Chronic Callers

Once we are able to accurately identify individual Chronic Callers we can then decide which Contact Model we would

like to implement. The 5 Contact models are:

• Chronic Callers Do Not Exist • Don’t Do Anything • No Engagement• Agency Dictated Contact Policy• No Therapy - No Contact• Note From the Therapist• Let’s Talk About Your Calls and Make a Plan

We have rules and information. What do we do with them?

Chronic Callers Do Not Exist

• Based on the principle that helping agencies exist to help any and all inquirers it denies Chronic Callers do exist.

• We may feel we are serving them appropriately by allowing unlimited access we may, in fact, be doing them a disservice

• Leads to “game” playing by Callers and staff

Don’t Do Anything • Admits there are such Callers but doesn’t address the issue

• Has the potential for the workers to interact with the Callers in any manner the see fit

• Leads to inconsistent re-enforcement

• This inconsistency leads to game playing and worker frustration

No Engagement Model

Means that once a Chronic Caller is identified as such we don't engage them anymore.

• This is the simplest Model to put in action

• Risk that a non-Chronic Caller may be identified as a Chronic.

• Can lead to game playing and acting out

• No investment in plan by Caller means little or no compliance

Agency Dictated Contact Policy

Means the agency establishes guidelines for interacting with the Caller.

• It is decision by the agency administration with input from the staff (usually) and no input from the Caller.

• The Caller may see this action as something being “done to them”.

• Making contact policy without the Caller’s involvement might make them angry and they may act that anger out against the line.

Means no agency contact with the Caller until they engage a more appropriate outlet for dealing with their issue.

• Repeated contacts can interfere with their reaching out to a more appropriate resource to resolve their situation.

•While not being able to contact the hotline may induce some Chronic Callers to get the longer-term assistance they need others will refuse.

No Therapy – No Contact

Refusal sends us back to square 1.

A variation of the No Therapy – No Contact Model addresses the Caller who is already getting help.

• Caller arranges for their provider to contact you to discuss the Caller’s calls and develop a contact plan

• Often the therapist will request the agency not allow the Caller call

• Therapist is apprised of issues they may not be aware of

• Confidentiality issues

How about the Note From the Therapist?

Can we talk about“Let’s Talk About Your

Calls” This Model makes the Caller a participant in the establishment of policy.

• Many Chronic Callers will partake in the process and, in fact, comply.

• Recognizes, delineates, and balances the Caller’s and the agency’s needs

• Recognizes the Caller may need help at some time

• The Caller feels they are part of the policy making process

• Models the behaviors of honesty and candor

• Re-enforces the concept contact is a privilege.

There is an extra special added bonus of the Interactive “Let’s Talk About Your Calls”

Model?Any ideas as to what it may

be?

It is possible the “Plan” will center on a agreement that the agency will contact the Caller.

• Agency can schedule the contacts for when they are best staffed.

• Training tool for new workers

• Affords new workers an opportunity to develop the skills without stress and anxiety

In order to facilitate the Let’s Talk Model we need to add some more information to our Chronic Caller

ProfileAdditions to the system include:

• Current Life Issues with which the Caller is coping

• The Caller’s Support System and Strengths

• The actual Plan as well as Limit, Focus and Rationale of the Plan

Once a policy is instituted it is important that...

• Staff, as well as the Caller, to adhere to it

• The policy process is explained to the staff

• We recognize Chronic Callers do develop crises which we will define as "Immediate Need".

• A Chronic Caller in Immediate Need will be treated as a regular Caller

• Once the Immediate Need is resolved the Caller would return to their contact policy

• Should the Immediate Need situation become long-term (chronic) it would become part of a new policy

What is “Limit”?

"Limit" addresses the number and duration of the Chronic Caller’s calls.

• The Limit is not an arbitrary choice

• It is not intended to be punitive.

• The Limit can be in terms of calls per day or week as well as a time limit

• Where the Caller’s contacts follow no discernible pattern or the contacts are intermittent no Contact Limit would be assigned Can you think of why

we wold not assign a limit in this case?

What is focus?

Focus addresses what we will discuss with the Chronic Caller during their contacts. Focus...

• Says we will not engage them in rehashing “Old News”.

• Encourages discussion of what is happening in the present and what they are doing to cope with it.

• Does not mean we will “just listen”

• Does mean we will interact with the Chronic Caller in a manner defined by the boundaries of their Limit and Focus.

What is Rationale?

• Rationale delineates how the Plan was created

• It gives the workers something to refer to should a particular Caller question a Plan that is being used

•It can be used to remind the Caller that the Plan was something they helped establish

•It allows workers who may feel “attached” to a certain Chronic Caller to understand that the Plan was not something arrived at arbitrarily

•It helps ensure the Plan will be implemented uniformly

How do I interact with chronic callers when establishing policy?

Remember:

• You will not be the first seeking to establish policy with the Caller.

• Use your active listening skills.

• To keep the discussion focused on the Caller and their needs.

• Being empathic does not mean lack of focus.

How else do I interact with chronic callers when establishing

policy?

Remember:

• To plan how you would like the interaction to go.

• To anticipate possible areas of resistance

• Allow the Caller to tell you what they think would be fair.

• Address the issue of therapy

• Keep in mind that “No” is an appropriate answer

Well thank-you for being such an attentive group. While there is no way to ensure you will never have to work with another Chronic Caller I do hope we have been able to develop some ideas that can serve to empower us to ameliorate their impact on our services. Ahem…I hope we also had a little bit of fun along the way.Any questions?

And Remember!

You can surrender!

Or adapt