Authors: Yasmin Dunkley & Nokubonga Ralayo
Question: “How do you spot participant distress over the phone?”
Summary: This piece of work is a direct response to the literature review “How to conduct remote research with adolescents in South Africa.” That review recognised that in changing how we conduct participant interviews (with phone based modalities) the visual clues and cues which often inform the researcher when working face to face are absent. This means that the relationship between interviewer and participant is changed, and the visual cues that show when a participant is becoming distressed are equally absent. This document starts by listing considerations around phone-based interviews that researchers may need to be mindful of when conducting this research for the first time, including the increased perceived intimacy of phone based interviewing, an increase in blurred boundaries between participant and researcher, and the potential for increased disclosures. It then provides a list of techniques for spotting when participants are becoming distressed, as well as some of the techniques for mitigating that distress. This piece of work continues by looking at some of the principles of self-care, and seeks to empower researchers to stop when they feel uncomfortable or at risk of vicarious distress. The intended audience of this piece of work is research assistants directly working with the Hey Baby, Mzantsi Wahko and TAG teams in the Western and Eastern Capes of South Africa. This document is intended to be a living document, to support field workers carrying out their remote research. The document will form the basis of ongoing training, supervision and debriefing around non-visual cues of distress, as well as support qualitative and quantitative phone based research methods. We are living through an unprecedented time. We decided to create this document to be proactive in supporting our team during the COVID19 epidemic and beyond. We recognise that field workers, ultimately, have the knowledge, skills and expertise to conduct research. This document is a tool to support and complement the good work that they are already doing. Moving forward and recommendations: This section briefly outlines some already decided steps, and some recommendations for the management of Hey Baby, Mzantsi Wahko and TAG teams to consider when thinking about the future direction of this piece of work.
Considerations Research assistants will be using phone based interviewing for the first time with the Hey Baby and TAG research projects. In switching from face to face work to remote work, it is important to note that the relationship between participant and researcher can change. Here are some of the key considerations for researchers to be aware of before conducting these interviews.
How do we identify distress over the phone? According to Dictionary.com, distress is “great pain, anxiety, or sorrow; acute physical or mental suffering; affliction; trouble” or a “state of extreme necessity or misfortune.” It can be the result of poor mental health, historic abuse, or even physical pain, which could be triggered by the interview process. Not all distress will require a referral. Sometimes the simple process of disclosing feelings can help the participant feel supported. Without visual cues, it can seem harder to identify when our participants are distressed with phone-based interviewing, however there are some techniques for assessing how participants are doing during interviews. 1.Assess the nonverbal: You will need to assess unspoken language to see how participants are doing. Ask yourself “Does the participant seem reluctant to respond?” 2.Tone of voice is a powerful form of non-verbal communication: Listen to the tone of the participant’s voice and listen to the words that they use, what could be “flag” words that identify all is not well? Listen for pauses, breathing, changes in voice patterns, background noises, as all of these will become significant. Listen to the tone and pace of the words being used, and the little inflections in the voice. On the phone, we can hear the slightest change in movement from our participants, what does that movement mean about the emotional state of the person you are speaking with? 3.Consistently check-in with your participants: Ask them “are you still OK?” If a participant sounds vulnerable, they may not speak up about it, so you can choose to ask them how they are feeling. To really find out what’s going on, we need to engage in a conversation with our participants, ask them how they are, truly listen to the answer, and encourage them to open up if they feel comfortable. Your pauses or silences for some young people will be difficult, and participants may wonder if you’re still there or whether you’re still listening. You will need to find a balance between letting the participant know you’re still present, whilst allowing the important silence for the participant to respond to your questions. Minimal encouragements can help to support this (mmhmm) or you might want to say more, ‘I’m still here…’ 4.Practice active listening: You will have been trained on some of the techniques of active listening (including the five key techniques to show you are listening. These are so useful when conducting phone based interviewing.
The best way that you can understand whether you participant is OK, is by listening to them, and asking them. Strategies to deal with distress: Often it will become clear very quickly if a participant is distressed. What can be more challenging is understanding what to do when a participant is distressed. There are levels to this, as if a participant is at risk of immediate harm, this is an emergency situation and requires immediate action in line with the HUBs safeguarding policies. Referrals are not discussed in this document, as they are covered in-depth in a separate referral pathways document. The referral pathways document specifically looks at what to do when a participant has made a disclosure in the following areas:
Techniques for managing distress:
What if the participant hangs up? This is a real possibility with phone based research. Debriefing can help you explore how you feel if a young person exercises their right to flee from an interview, or their emotions, by hanging up a call. Those who feel the need to escape or remove themselves from a difficult feeling or situation may find it easier to do so by putting down the phone than they would do walking out of an interview. It is important to consider what you would do and how you might feel ahead of this could, so you can mentally prepare for the eventuality if it does happen. What will it be like if you aren’t able to reconnect? When does a risk assessment come into play? How do you determine whether this was about their right to respond to a difficult feeling to look after themselves or whether there is something of a more serious nature at play that needs to be acted upon? These are questions to explore in training, debriefing and in supervision. Self-care strategiesSelf-care is very important when you are engaging with participants. This includes practicing self-awareness; when you feel overwhelmed and you are not OK in the middle of a conversation, don’t be afraid to take a step back. You can make any excuse to stop the call and find the time to look after yourself. Some of these measures may help you look after yourself during an interview: 1.Set clear boundaries: When you call your participant you introduce yourself and the purpose of your study – it’s a type of contracting. Do not be afraid to revisit the purpose of your call. We are not trained counsellors, therefore when you can sense the conversation is getting deeper than you are able to hold in your capacity, be honest with the participant, and tell them you can hear they are going through a lot, but that you are not a trained counsellor. You can then explore with them some referral pathways. Offer that resource to them rather than trying to bear the burden yourself. 2.Keep your team updated and debrief: It is OK to not know what to do. Take the time with your manager or a colleague and discuss your interviews. 3.Take time for you: Take a step back often. Being on the front line means being in the heat of the moment, and we always need time to reflect and flush out the heat. Take your time and give yourself space when interviewing participants. Take a break when you feel frustrated. Know that you are allowed to pause your interviews to collect yourself. Stop, go for a walk, whatever makes you feel relaxed. When you cannot keep calm, make any excuse to take your break and find that calmness. You don’t have to let it all in and listen and you are not there to fix all of the problems that you will hear. You need to look after yourself, so that you can be the best researcher possible for your participants. 4.Use a counsellor or call a helpline: Do not be afraid to use the services on offer for yourself. In many ways, hearing what are participants are going through will remind us of what has been happening in our own lives. You are going through this COVID19 experience as well. Do not be afraid to reach out. 5.Find out how to build your resilience and develop a resilience toolkit: Attached to this document, is an article about the RESPECT model. This is a model of self-care that suggests ways of building ourselves up to be able to withstand or manage stressful or traumatic experiences. The model suggests that we find ways to do the following when we feel overwhelmed:
6.Finally, be kind to yourself: You are not going to get it right all of the time. It is OK to make mistakes, and we can all learn from them. MIND Resources
References The content in this document was informed by the following professionals and agencies, and we are grateful for their support.
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