Tobacco Cessation “Care-frontation:”

1. Tobacco Cessation “Care-frontation:” Communication Techniques for UM Ambassadors

2. University of MiamiMiller School of Medicinewill be a Smoke-Free Campus Effective March 2010

3. Participants will: Learn how to confront a smoker in a non-confrontational manner Review and practice de-escalation techniques

4. Understand… • Nicotine is a highly-addictive substance and it is hard to quit smoking • The Smoke-Free Campus policy intends to: • Respect both smokers and non-smokers • Offer support to people who want to quit or suspend smoking

5. All employees are empowered to enforce the Smoke-Free Campus Policy by: • Politely confronting employees, patients and visitors who are smoking • Reminding them that UM is a smoke-free campus

6. “Care-frontation” • Remain polite and non-confrontational • Be calm and state your concern directly • Provide the person with a card that explains the policy and provides them with a hotline number

7. Scripting • Say: “Did you know that UM has a policy that prohibits smoking on campus?” • Or say: “You are asked not to smoke on property, but you may smoke on the public sidewalk or street. Thank you.”

8. If they engage you in conversation about the policy: • You can explain the policy is in place to protect UM staff, patients, students and visitors from the harmful effects of second-hand smoke.

9. People May Become Escalated… • …When they are presented with feelings, circumstances or situations with which they are unable to cope. • Visitors and patients may already be under stress due to circumstances that brought them to the hospital • Now we are asking them to stop doing something that, for some, is a temporary way of coping

10. Raised voice Rapid speech Excessive hand gestures Fidgeting Shaking High-pitched voice Pacing Balled fists Erratic movements Aggressive posture Warning Signs of Escalation:

11. MOST IMPORTANT RULE: TRUST YOUR INSTINCTS! • If you assess or feel that any of these de-escalation techniques are not working, STOP! • Call for help or leave yourself and call security or the police, depending on your work location. • Under no circumstances should you place yourself in a position that jeopardizes your safety.

12. Importance of Non-Verbal Communication: • Approximately 65% of communication consists of non-verbal behaviors.  • Of the remaining 35%, inflection, pitch, and loudness account for more that 25%, while less that 7% of communication has to do with what is actually said. 

13. De-Escalation Techniques • Appear calm, centered, and self-assured even if you don’t feel it.  • Maintain limited eye contact. • Practice maintaining a facial expression that is neutral, calm and attentive. • Keep a relaxed and alert posture. • Minimize your own body movements (excessive gesturing, pacing, fidgeting, or weight shifting). 

14. Things to Avoid: • Pointing or shaking your finger • Touching the individual (even if touching is generally culturally appropriate or usual in your setting) • Confronting an individual in an isolated area when there is no one else around

15. Position Yourself for Safety • Never turn your back for any reason • Maintain a distance of at least 2 arms’ length • Angle your body at 45 degrees • Place hands in front of your body in an open and relaxed position • If possible, casually position yourself behind a barrier or large object • Position yourself closest to the exit/ escape route

16. Verbal De-Escalation • Once non-verbal tactics are in place, verbal de-escalation can be the next step • Remember, reasoning with an enraged person is not possible • The first and only objective is to reduce the level of agitation so that discussion becomes possible

17. Verbal De-Escalation Guidelines: • There is no content except trying to calmly bring the level of arousal down to a safer place. • Use a modulated, low monotonous tone of voice. • Do not get loud or try to yell over a screaming person. • Wait until he/she takes a breath, then speak calmly at an average volume.

18. Verbal De-Escalation Guidelines: • Do not be defensive even if comments or insults are directed at you or anyone else. • Be very respectful even when firmly setting limits or calling for help. • Answer only informational questions, no matter how rudely asked. Do not respond to abusive questions. • Be honest but do not volunteer information which may further upset the individual.

19. Verbal De-Escalation Guidelines: • Explain limits and rules in an authoritative, firm, but respectful tone.  • Give choices, where possible, in which both alternatives are safe ones (“would you like to take a smoke break later or smoke over there?”) • Empathize with feelings but not with the behavior. • Suggest alternative behaviors where appropriate.

20. Verbal De-Escalation Guidelines: • Do not solicit how a person is feeling or interpret feelings in an analytic way. • Do not try to argue or convince. • List consequences of inappropriate behavior without threats or anger. • Represent external controls as institutional rather than personal. • If the person does not respond positively, remain polite and considerate and walk away.

21. Role Plays • Get into groups of threes • One person plays the smoker, one person plays the ambassador, and one person is the observer • Observers take notes and give feedback • Then switch roles until you have each had a turn playing ambassador • How did it go?

22. Remember… • Most situations will not escalate to a hostile level. • With the right approach, the majority of people will calmly comply. • It is better to walk away than to place yourself in danger. • Regardless of the outcome, you have made an effort to support the policy and it is appreciated. THANK YOU!