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Hacks for Reaching Affirmation & Accord

Written by Nigel Brunsdon on . Posted in Hacks for Addressing Escalation.

One of the main goals of active listening with an agitated person is reaching affirmation and accord. You are looking to try and find ways to agree with the person who is agitated. Even if you don’t entirely agree with the person, try to find at least a small way in which they may be right, or in which you can be on the same page, or team, with them. Some tips for getting there include:

  • Where possible agree with the agitated person.
  • Try to get ”on the same page” with the agitated person.
  • Affirm or re-affirm the validity of feelings.
  • Find ways to solve issues together.
  • Try and get “on the same side” with the agitated person.
  • Suggest solutions that draw the agitated person into deeper conversation or to consider more variables.
  • Offer a sincere apology for any wrong-doing or mistakes. Not for an imaginary wrong, but a sincere apology for anything in the situation that was unjust; a simple acknowledgment that something occurred that wasn’t right or fair can go a long way toward making a person feel heard. Remember: it is possible to apologize without entirely agreeing or “taking all the blame.”
  • Ask the agitated person to voice their criticism of the listener. (“What am I doing wrong that makes you so angry at me? Tell me, I can take it. Don’t hold anything back. I want to hear about everything you’re angry about.”) Simply venting can help calm someone.
  • Do not personalize.
  • Simply ignore or deflect questions about your authority, that challenge you, or that are insulting.
  • Appeal to an authority outside of yourself if appropriate.

Hacks for Non-Verbal Active Listening

Written by Nigel Brunsdon on . Posted in Hacks for Addressing Escalation.

When someone is agitated or in distress, how we carry ourselves can make a huge difference. Non-verbal cues—like posture, breathing, and personal space—can either calm a situation or escalate it further. The following tips offer guidance on using body language to reduce tension, show respect, and create a safer, more grounded interaction.

Some things to keep in mind in terms of body posture or non-verbal communication that will reduce overall stress and agitation include:

  • Breathing—As discussed, breath literally tells the brain to calm itself. Remember to keep breathing as deeply and calmly as possible during the incident. Avoid holding your breath or breathing rapidly as these behaviors can increase cortisol levels and tension. This can take practice.
  • Try to always be at the same eye level. Encourage the person to be seated, but if they need to stand, you stand up also. Try to never be in a position looking down on the participant.
  • If possible, allow extra physical space.
  • Do not turn your back on the participant. This can feel disrespectful, may agitate them, and puts you in a more vulnerable position.
  • Do not stand directly in front of a participant. Stand at an angle, it is less confrontational and allows you to sidestep away if needed.
  • Maintain a full-leg “kick distance” away from the agitated person.
  • Do not maintain eye contact as this can feel challenging and may exacerbate the situation. Allow the participant to break their gaze and look away.
  • Do not point or shake your finger.
  • DO NOT smile. This could look like mockery or anxiety.
  • Do not touch, even if some touching is generally culturally appropriate and usual in your setting. Agitated participants may misinterpret physical contact as hostile or threatening.
  • Keep your hands visible and relaxed, not fisted or hidden.

Hacks for Empathetic Active Listening

Written by Nigel Brunsdon on . Posted in Hacks for Addressing Escalation.

Once you have grounded yourself during an escalated situation, next engage in active listening with the person who is agitated. This can seem counterintuitive or difficult when you are dealing with somebody who is, for example, screaming at you, and it may feel like you’re rewarding them for being completely irrational. But it is key to getting them more centered and grounded so they’re less agitated and less likely to become a danger to themselves or others.

Active listening is a term often used to describe a general approach to listening that helps you gain more information, improve your understanding of other points of view, and work cooperatively with superiors, subordinates, and peers. This approach requires not just that you learn and remember more of what the other party has said, but also that you communicate your interest and involvement to that party as well. Active listening requires effective use of verbal and nonverbal communication, as well as mental and emotional discipline. It is actually two different things: Both nonverbal active listening skills and verbal active listening skills.

Active listeners:

  • Look and sound interested in the speaker. By conveying your interest, you can encourage the speaker to communicate more extensively and to clarify and expand on thoughts and feelings. Communicate your interest by maintaining good eye contact. (In American culture and many Western cultures, this means looking into the other person’s eyes much, though not all, of the time. Too much eye contact may make the speaker feel self-conscious, but too little will make them feel ignored). Maintain a body position and facial expression that indicate attentiveness, not boredom. Nod encouragingly to show understanding and interest. Avoid drawing, playing with your pen, or other distracting behaviors. (Conversely, try not to be distracted by the speaker’s mannerisms.) Use vocalizations such as “uh-huh” and “yes” to encourage them to continue.
  • Adopt the speaker’s point of view. You will understand and remember the speaker’s points most effectively if you try to see things from their point of view, at least initially. Try to listen, not to interrupt, finish sentences, or rush the speaker. Most of all, try to suppress your initial reactions and to hear and understand the speaker’s perspective. Try to listen and respond from the speaker’s frame of reference, not your own. Listen for feelings, not just words. Try to empathize with their position. Depending on the context and purpose of your communication, you may later shift modes into a discussion in which you also present your own point of view; but to be a good active listener, you shouldn’t do that until you thoroughly understand the speaker’s point of view.
  • Clarify the speaker’s thoughts and feelings. You will listen better if you are not talking too much yourself. When you are in active listening mode, limit your talking to things that will contribute to getting the fullest informational and emotional content from the speaker. Avoid inserting your own marginally-related experiences and minimize interruptions. When the speaker pauses, ask open-ended questions (e.g., “How do you feel about X?” “Tell me about X.” “What concerns you about X?” ) rather than questions that can be answered in a single word or phrase (” Are you satisfied with X?” “Is X on schedule?”). Use reflective response techniques (described in more detail below) to check the accuracy of your understanding of the speaker’s ideas and especially feelings (e.g., “So you are frustrated at your inability to progress on X?”). You may adapt active listening techniques to different types of listening, with your role ranging from minimal intervention to more active solicitation and even into giving advice, depending on your needs and the situation.
  • Offer reflective responses. Reflection, or reflective response technique, borrowed from certain types of counseling methods, is designed to elicit the speaker’s thoughts and feelings as fully as possible. It is a way of helping someone explore their own personal feelings. This technique involves reflecting back to the speaker what you believe they have said in order to verify (or clarify) your understanding and to encourage the speaker to continue elaborating on their point of view. Reflect the speaker’s thoughts and feelings: Restate what you believe the speaker has said to check for the accuracy of your understanding (e.g., “So you couldn’t finish the assignment on time.” “Then you think the time allotted was inadequate?”). Even more importantly, reflect back the speaker’s feelings as you have heard or inferred them (e.g., “You seem to feel anxious because you couldn’t finish the assignment on time.”). This interpretation of feelings is more tricky because it often requires you to read between the lines, to infer feelings underlying what has been said (e.g., “You seem angry about the reorganization,” rather than ” So the department was reorganized.”). Thus you may want to use wording or voice tone to phrase your inferences as questions, rather than statements (e.g., “So you feel anxious because you couldn’t finish the assignment on time.” becomes “Do you feel anxious because you couldn’t finish the assignment on time?”).
  • Respond rather than lead the conversation. Let the speaker’s thoughts and feelings be your guide in the conversation. Don’t guide the conversation by asking questions or interjecting ideas or suggestions that lead the speaker into new areas of interest to you (e.g., “Have you thought about X?” “Maybe you should ask about Y.”). Instead, respond to and reflect back what was actually said or what you sense is implied by what was said (e.g., “So you feel trapped by this project?”). Try to stay within the speaker’s frame of reference, rather than asking questions or making suggestions that come from your own frame of reference. Even asking “Why?” may distract the speaker from one line of thoughts or feelings into defending and justifying thoughts, feelings, or actions.
  • Respond to feelings, rather than content. As suggested earlier, feelings are generally a better indication of personal meanings than content is. Thus you will help the speaker’s self-exploration more by responding to their feelings (e.g., “So you resent Susan’s frequent absences?” ) than to the content (e.g., “How often was Susan out of the office?”) There is a corollary to this guideline: You can get at a person’s feelings better by responding to the more personal aspects of what they say. Whenever possible, choose the specific, personal points (e.g., “So you and Inez disagree about what goes in outreach kits?”) rather than the abstract generalizations (e.g., “So everybody is just doing whatever they want?”) to respond to and reflect back at the speaker. This encourages them to explore those personal feelings more thoroughly and to make clear their own assumptions.

Hacks for Staying Present

Written by Nigel Brunsdon on . Posted in Hacks for Staying Present.

As discussed in the part of the site on preventing escalation, it is essential for harm reduction workers to stay present and remain centered and relatively calm during escalated events.

This is one of the hardest things to do, but staying present and centered during any kind of escalated situation at your harm reduction site is essential to de-escalation.

Here are some hacks:

  • Breathe—This is the most critical thing you can do when you are emotionally agitated, which is inevitable if somebody is yelling at you—especially if you have a history of trauma yourself. If you feel yourself becoming agitated, think of your breath and practice deep breathing. Consciously inhale for four counts, and then exhale for four counts. This can help calm your nervous system and help you focus without becoming engaged with the agitated person.
  • 5-4-3-2-1 Technique—The 54321 technique is a technique to help ground you in an agitated situation. Identify five things that you can see, four things that you can touch, three things that you can hear, two things that you can smell and one thing that you can taste. This helps you ground and refocus yourself in your body.
  • Body Scan—The body scan technique moves your attention from your emotions to your body. Slowly scan your body from your feet to the top of your head, directing your attention and awareness to each part of your body. This will pull you away from immediate response to the agitating person.
  • Math—This sounds a little odd, but doing arithmetic in your head can pull you into your frontal lobe and make you less emotionally reactive. Simply adding or subtracting simple numbers in your head can help bring your own emotional reactivity into control. Combine this with other techniques for it to be especially effective.
  • Name the Emotion—Most of us, when we’re having an emotional reaction, are so caught up with it that it’s hard for us to even think in words. Naming your emotions will help refocus and ground you.
  • Reality Check—Remind yourself that being triggered doesn’t mean that you need to respond to your body. Remember, just because you feel a certain way doesn’t mean that what you’re feeling is something real or something you need to respond to. Check in with yourself about the facts. This is especially useful when somebody is insulting you to your face. It can be very easy to become reactive unless you’re very carefully reality testing to see whether this person’s opinion is actually meaningful.

Hacks for Community Member Agreements

Written by Nigel Brunsdon on . Posted in Essential Policies and Procedures for All Harm Reduction Sites and Services.

Community member agreements are shared agreements regarding behavior expected of everyone who participates in a harm reduction site or service. Harm reduction leaders were careful to say that these agreements should be simple and err on the side of some ambiguity in order to make room for a variety of different potential behaviors. The primary rule all harm reduction leaders talked about was the need to treat everyone with respect. Many referred to this as the “don’t be an asshole” rule. All said that one of the main rules community member agreements should include is something to the effect of “be respectful”.

Some nearly universal community member agreements in harm reduction spaces include:

  • Respect: Treat everyone with honesty, kindness, and respect.
  • Inclusivity: Ensure that the space is welcoming to people of all backgrounds, abilities, and identities. Avoid behaviors or language that could exclude or marginalize others.
  • Consent: Always ask for and respect personal boundaries. Obtain consent before touching people or their things, taking photos or filming, or sharing personal information with third parties.
  • Non-Violence: Maintain a peaceful and non-violent environment. Physical aggression, threats, or any form of violence is prohibited.

Other common agreements include:

  • Confidentiality: Respect the privacy of others. What is shared in the space, and whether you met or have seen each other at the site, is private.
  • Conflict Resolution: We address conflicts calmly and respectfully. Try to resolve things peacefully or seek help from a staff member.
  • Community Care: We look out for one another here. We all belong here and we’re all responsible for the space/service. Please clean up after yourself, keep music down, and take care of one another.
  • Accessibility: Please keep aisles and walkways clear, refrain from using heavy scents, tie up your dog or bike, and only take up one seat at a time to ensure enough for everyone.

Many programs find the need to add specialized agreements over time as situations arise. As one valued harm reduction leader quipped, “but they surprise you. I never would’ve thought I needed a rule about not having your genitals out in the drop-in, but here we are.”

Harm reduction leaders also suggested involving participants or at least Community Advisory Boards in making choices for the community agreements as well as periodically reviewing those agreements with those same bodies in order to ensure participant buy-in for these important community standards.

Hacks for Service and Supply Management

Written by Nigel Brunsdon on . Posted in Essential Policies and Procedures for All Harm Reduction Sites and Services.

Many of the harm reduction leaders that were interviewed for Space Hacks talked about how critical it is to effectively manage services, supplies, and inventory in order to maintain community tranquility. It may not feel intuitive, but OGs report that ineffective management of supplies is the number one potential flashpoint for escalated situations during harm reduction services. Some general tips for all service and supply management are to:

  • ALWAYS be scrupulously fair with your distribution of supplies. There is nothing more likely to cause conflict than your participants feeling like they’ve been treated unfairly.
  • Be consistent in how supplies are distributed and managed across team members and locations.
  • If applicable, have folks form lines and find ways to ensure that it is respected.
  • Ensure cross-team communication and that everyone is committed to the same policies and expectations.
  • NEVER make exceptions to boundaries without transparent, explicable parameters.
  • Be a steady regular presence in the community—show up, and if you can’t, communicate why.
  • Be transparent about your services and supplies—what is available and what isn’t.
  • Explain yourselves—let participants know why you provide certain supplies, services or services a certain way. People are always more likely to follow rules or expectations if they understand why it is important.

Post-Exposure Prophylaxis Hacks

Written by Nigel Brunsdon on . Posted in Hacks for Accident Prevention in Harm Reduction Services & Spaces.

Though largely unsupported by scientific evidence, the dangers of needle stick injury loom large in the popular imagination. As a result, the emotional response to needle stick injury can be intense even if, statistically, the risks are quite low. For this reason, if no other, it’s essential that harm reduction organizations be prepared for how they might deal with such an eventuality. For most, this means having a post-exposure prophylaxis protocol on hand. This is a protocol for what happens in the event of needle stick injury. Usually, it includes some kind of evaluation of the situation and criteria for deciding whether to take prophylactic medication for HIV. A typical course of these medications is 28 days and there are a variety of risks and benefits that should be considered by each individual before they decide whether or not to do PEP. It is therefore strongly recommended that these protocols be developed and discussed long before any such incident takes place.

This will mean that harm reduction organizations will need a relationship with a doctor or clinic that can provide these medications or a supporting prescription. Again, it’s best to make these connections sooner rather than when they’re needed. Harm reduction leaders report that most doctors who provide HIV care are more than willing to help in this respect as long as these discussions are held ahead of an event.

Universal Precautions: Gloves

Written by Nigel Brunsdon on . Posted in Hacks for Accident Prevention in Harm Reduction Services & Spaces.

Medical gloves should be worn whenever handling exposed or used supplies, especially those that might be used to prepare or use injection drugs such as syringes, cottons, cookers, tourniquets, and ascorbic acid. Gloves should be changed often, especially between activities or participants.

To remove gloves, first grasp the outside of one glove at the wrist without touching your bare skin. Next peel the glove away from your body, turning it inside out. Then, holding the glove you have just removed in your gloved hand, peel off the second glove by placing the finger of your clean hand into the top of the glove and rolling it back. This avoids cross-contamination.

Harm reduction workers are also encouraged to wear thick leather or rubber work gloves for environmental cleanup and clearing areas of sharps.

Universal Precautions and Workplace Safety

Written by Nigel Brunsdon on . Posted in Hacks for Accident Prevention in Harm Reduction Services & Spaces.

Though not all harm reduction organizations or programs are in need of universal precautions or OSHA considerations, most are. It’s important when setting up a harm reduction space to take into consideration the important and real risks of harm reduction work. This includes the potential for entry and exposure to blood-borne pathogens as well as airborne pathogens.

Important Definitions

Airborne pathogen—Pathogenic microorganisms present in the human mouth, lungs, or throat that can cause disease in humans through wide airborne dispersal. These pathogens include, but are not limited to, measles morbillivirus, chickenpox virus, mycobacterium tuberculosis, influenza virus, enterovirus, norovirus, and less commonly coronavirus, adenovirus, and possibly respiratory syncytial virus.

Bloodborne pathogen—Pathogenic microorganisms present in human blood that can cause disease in humans. These pathogens include but are not limited to the ones that harm reduction workers are most at risk from, including hepatitis C virus (HCV), hepatitis B virus (HBV), human immunodeficiency virus (HIV), as well as those that pose lesser risk such as tetanus and syphilis.

Droplet borne pathogen—Pathogenic microorganisms present in respiratory droplets, generated by coughing, sneezing, or talking. Respiratory droplet transmission is the most common route for respiratory infections. Transmission can occur when respiratory droplets reach susceptible mucosal surfaces, such as in the eyes, nose, or mouth. This can also happen indirectly via contact with used surfaces when hands touch droplets and then touch the face. Respiratory droplets are large, cannot remain suspended in the air for long, and are usually dispersed over short distances. Viruses spread by droplet transmission include influenza virus, rhinovirus, respiratory syncytial virus, enterovirus, norovirus, measles morbillivirus, and coronaviruses such as SARS coronavirus (SARS-CoV-1), and SARS-CoV-2, which causes COVID-19.

Un-used supplies—Unused harm reduction or safer sex materials still in their original packaging or containers which are not subject to potential contamination such as bagged supplies. Examples include packed or bagged syringes and supplies, cases or boxes of materials and so on.

Exposed supplies—Unused harm reduction or safer sex materials no longer in their original packaging or containers which are subject to potential contamination or substantial risk of passive or indirect exposure. Examples include unpacked syringes, un-boxed cookers, un-bagged cottons, and so on.

Used supplies—Harm reduction or safer sex supplies which are used and subject to potential contamination or a substantial risk for cross-contamination. Examples include used syringes, cookers, cottons, tourniquets, and so on.

Sharps—Any object whose primary purpose is to pierce the skin such as syringes, needles, lancets, autoinjectors, infusion sets, IVs, scalpels, etc.

Bio-waste or sharps container—Hard-sided containers marked with a biowaste symbol used to dispose of all materials that might be contaminated with hazardous or biological waste. For harm reduction, this includes syringes, tourniquets, cottons, cookers, wound care supplies, and so on.

Cross-contamination—The process by which pathogens are unintentionally transferred from one substance or object to another. Examples include touching surfaces or used sharps or supplies and then touching one’s mouth or an open wound.

Exposure control plan (ECP)—The official workplace exposure control plan for a workplace under OSHA guidelines based on OSHA standard 29 CFR 1910.1030.

Personal protective equipment (PPE)—Equipment worn to minimize exposure to hazards that can cause workplace injuries and illnesses. For bloodborne pathogen control, PPE can also include lab coats and gowns, splash guards, gloves, and goggles. For air- or droplet-borne pathogens, PPE includes gloves, face masks, and goggles.

Policy Creation Hacks

Written by Nigel Brunsdon on . Posted in Hacks for Organizational Boundaries and Policy Development.

Creating effective policies in harm reduction work means grounding them in your mission, being thoughtful about their impact, and ensuring they’re both practical and inclusive. The tips below offer a starting point for organisations looking to build policies that reflect their values, meet external requirements, and genuinely support the people they serve and work with.

  • Lead with your mission and values—Decide as an organization on your values and purpose and let those lead all of your policy decisions.
  • Don’t reinvent the wheel—Look at, and reproduce where appropriate, policies from similar organizations.
  • Double check the rules—Ensure your decisions can be upheld and meet all requirements by consulting experts such as lawyers, program officers, and/or insurers.
  • Get buy-in—Policies work best when they are supported by the people they impact.
  • Involve others—Whenever possible, ensure that the people primarily impacted by a policy are a part of creating them.
  • Be realistic—Make policies practical and reasonable in the context of the realities, time, and resources of those impacted by them.
  • Explain yourself—Explaining the reasons for a policy always ensures greater buy-in from the folks impacted by it.
  • Choose a time—Create policies during the time your organization sets aside to focus on internal activities such as retreats or planning sessions.
  • Be strategic—Choose what policies to enact and when, based on the needs and experiences of your organization.
  • Have foresight—Try to anticipate the policies most critical to your work. You can base this on your experience or the experiences of existing organizations.
  • Know your must-haves—Create the policies required by outside entities such as financial institutions, funders, or insurers.
  • Don’t overdo it—Don’t bother creating a lot of policies about things that have not, and may never, occur in your agency (unless you are required to do so to meet a legal or contractual obligation).