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Tobacco Cessation “Care-frontation:”

Communication Techniques

for UM Ambassadors


University of MiamiMiller School of Medicine

will be a Smoke-Free Campus Effective

March 2010


Participants will:

Learn how to confront a smoker in a non-confrontational manner

Review and practice de-escalation techniques


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-smokersOffer support to people who want to quit or

suspend smoking


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


“Care-frontation”

Remain polite and non-confrontationalBe calm and state your concern directlyProvide the person with a card that

explains the policy and provides them with a hotline number


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.”


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.


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


Warning Signs of Escalation:

Raised voiceRapid speechExcessive hand

gesturesFidgetingShaking

High-pitched voicePacingBalled fistsErratic movementsAggressive posture


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.


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.


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).


Things to Avoid:

Pointing or shaking your fingerTouching 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


Position Yourself for SafetyNever turn your back for any reasonMaintain a distance of at least 2 arms’ lengthAngle 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 objectPosition yourself closest to the exit/ escape

route


Verbal De-EscalationOnce non-verbal tactics are in place,

verbal de-escalation can be the next stepRemember, reasoning with an enraged

person is not possibleThe first and only objective is to reduce

the level of agitation so that discussion becomes possible


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.


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.



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.



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.


Role Plays

Get into groups of threesOne person plays the smoker, one person plays

the ambassador, and one person is the observerObservers take notes and give feedbackThen switch roles until you have each had a turn

playing ambassadorHow did it go?


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!

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