Mrs. S wasn’t at all confident that she could quit smoking. But when social worker Michael Etheridge called her at home to see if she would give it a try, she responded eagerly to his invitation to set herself a goal: she’d cut down from 10 cigarettes a day to 6 over the next two weeks.
Michael was surprised when his follow-up phone calls two weeks later were not returned, but he moved on, continuing with other calls in the smoking-cessation outreach he was doing to members of VNSNY CHOICE Health Plans who were in fragile health and had complex needs. Each person he was calling had indicated in surveys that they smoked and were interested in quitting.
About six months later, Michael had the opportunity to call Mrs. S again in another round of outreach, and she quickly responded and recalled the earlier phone call. “I have something to tell you,” she said with delight. “I quit smoking three months ago!”
Cigarette smoking is America’s leading preventable cause of death, and as reported in the New England Journal of Medicine, any program that reaches smokers with messages about the health dangers of cigarettes has real value. It’s never too late to stop smoking—at any age—and the benefits of cessation can help improve and reverse some previous damage
Programs like the one offered by VNSNY CHOICE (initiated in our SelectHealth special-needs program for people with HIV and soon to roll out to a wider group) go the extra mile in truly partnering with smokers. Beginning with a personal call, our social workers offer education on the overall health effects of smoking as well as counseling on quitting, and we work hand in hand with smokers to set and follow a course of action—of their own choosing.
We create an opportunity and offer the support a smoker needs to seize it. “More than once, I’ve heard, ‘You know, because you called me today, I feel like I can do it. I will try to quit,’” explains Michael, a clinical support licensed social worker for VNSNY CHOICE’s Department of Social Work and Behavioral Health. “People actually leapt at the chance. They saw my phone call as an opportunity to do something that they’d been meaning to do.”
Here are some key features of that support:
Meet People Where They Are
You’ll notice that the initial conversation with Mrs. S did not focus solely on quitting. Ten cigarettes a day—how about simply cutting down? Knowing full well the vagaries of life that lead people to and keep them smoking, Michael never passes judgment. “Let’s start where you are and be practical about it,” he explains, summarizing his objective.
“I would never say, ‘I’m calling you because you smoke and you should stop and here’s how,’” he says. “They’ve filled out a survey to tell us how motivated they are, and that’s where we start. That allows us to be very real with people.”
Listen Actively
“As a social worker, we use our voice to greet, offer care and listen. It’s all about listening,” says Michael. Active listening involves putting a conversation into motion and letting the other person talk while you remain present but, for the most part, silent. It’s harder than it sounds and something social workers are quite skilled at. By listening and letting the member respond to invitation or opportunity, Michael knows that the actions that follow are more likely to come with the member’s conviction.
Active listening also involves reflecting back what you hear, so the other person truly knows you are listening. Often what Michael hears when he listens is ambivalence over quitting. “I might say, ‘You seem fairly comfortable with your level of smoking since you’ve cut back, but you also said you had an interest in quitting. So I hear a mix. Is that right?’,” he says. “That makes the person on the other end of the phone feel heard and comfortable.”
Invite Achievable Goals
At the center of the program is personal goal-setting, an essential part of creating a successful plan of care for any health issue. “Anyone trying to make a change in a habit finds it helpful to set a measurable goal in that direction,” notes Michael. “When a person sets their own goal, they are not being pushed, so there’s no reason to be defensive.”
Health care goals work best when they are measurable, challenging and achievable. Mrs. S’s goal to cut from 10 down to six cigarettes a day is a great example. Michael still recalls when one member, a gruff man with an I’ve-been-smoking-for-40-years-and-I’m-not-about-to-quit-now attitude, replied when prompted, “Sure, I’ll set a goal. I’ll give those New York Quits people a call.”
Says Michael, “This goes to show you that when you lay out in front of people that something can be done, that you can take a practical step towards better health, they respond in ways that might surprise you.”
Provide Wrap-Around Support
We invite our members to call New York’s Smokers’ Quitline or make an appointment with their primary care physician for medication-assisted therapy to quit smoking. Recognizing that step is difficult but vital for some, we also offer to make that call together with the member. The program works as a partnership in smoking cessation—we’re not Big Brother. “Often people are amazed that we do this,” said Michael, referring to the invitation to make the next-step phone call together.
Building on personal contact, Michael follows up with a phone call a couple weeks later to check in on progress and offer ongoing support as well as a sympathetic ear. While Michael was not able to reach Mrs. S in his first round of follow-up calls, when he did reach her later on she said, “I’m so glad you called back. I really appreciate these phone calls.” And then she told him about how she seized the opportunity he had presented.
Care Beyond Smoking Cessation
These best practices extend beyond smoking cessation to caring system-wide for vulnerable populations, including the elderly, those suffering from chronic physical or behavioral conditions, and those on Medicare, Medicaid or otherwise underserved.
The smoking cessation program honors each person as a complex whole, recognizes that for care to succeed it must be responsive and collaborative, and puts into place the ongoing personal support needed to battle ongoing health challenges. We must employ these practices day in and day out throughout the city if we want to keep New York’s most vulnerable as safe and healthy as possible in their own homes and communities.