1. UHealthSmokeFree.com Area Health Education Center ahectobacco.com Tobacco Cessation “Care-frontation:” Communication Techniques for UM Ambassadors

2. UHealthSmokeFree.com Area Health Education Center ahectobacco.com University of Miami Miller School of Medicine will be a Smoke-Free Campus Effective March 2010

3. UHealthSmokeFree.com Area Health Education Center ahectobacco.com Participants will:  Learn how to confront a smoker in a non- confrontational manner  Review and practice de-escalation techniques

4. UHealthSmokeFree.com Area Health Education Center ahectobacco.com 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. UHealthSmokeFree.com Area Health Education Center ahectobacco.com 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. UHealthSmokeFree.com Area Health Education Center ahectobacco.com “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. UHealthSmokeFree.com Area Health Education Center ahectobacco.com 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. UHealthSmokeFree.com Area Health Education Center ahectobacco.com 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. UHealthSmokeFree.com Area Health Education Center ahectobacco.com 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. UHealthSmokeFree.com Area Health Education Center ahectobacco.com Warning Signs of Escalation:  Raised voice  Rapid speech  Excessive hand gestures  Fidgeting  Shaking  High-pitched voice  Pacing  Balled fists  Erratic movements  Aggressive posture

11. UHealthSmokeFree.com Area Health Education Center ahectobacco.com 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. UHealthSmokeFree.com Area Health Education Center ahectobacco.com 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. UHealthSmokeFree.com Area Health Education Center ahectobacco.com 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. UHealthSmokeFree.com Area Health Education Center ahectobacco.com 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. UHealthSmokeFree.com Area Health Education Center ahectobacco.com 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. UHealthSmokeFree.com Area Health Education Center ahectobacco.com 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. UHealthSmokeFree.com Area Health Education Center ahectobacco.com 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. UHealthSmokeFree.com Area Health Education Center ahectobacco.com 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. UHealthSmokeFree.com Area Health Education Center ahectobacco.com 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. UHealthSmokeFree.com Area Health Education Center ahectobacco.com 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. UHealthSmokeFree.com Area Health Education Center ahectobacco.com 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. UHealthSmokeFree.com Area Health Education Center ahectobacco.com 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!